Category Archives: health

The doubling danger

Think of someone you hate, someone you detest in your gut. Then ask yourself, is there anything about them that reveals something about you, something you’d rather not admit to yourself? What a frightening thought! It’s even more frightening when this hated other has the same name as you, looks like you or is like you in some other way.

            Naomi Klein’s new book Doppelganger delves into this eerie psychological domain. A “doppelganger” is a double, a person like you except with all the features you dislike or don’t want. Imagine encountering your doppelgänger.

In popular culture, this psychological dimension is often missing, and a doppelgänger is merely a lookalike. Klein’s analysis goes beyond appearances.

            Klein is an accomplished researcher, writer and social critic. She wrote the book No Logo, which exposed the ubiquitous process of commercial branding that has been taking over the world, and told about challenges to it. She later wrote The Shock Doctrine, about how powerful corporations zoom into areas hit by disasters — war, hurricanes — to make supersized profits. In several books, she has presented passionate arguments for action on climate change.

            As a prominent intellectual with a well-defined persona as a social critic, a scourge of neoliberalism, it might seem that Klein’s identity was both well-established and secure. But then she encountered a different Naomi, and many people confused the two of them.

            The other Naomi, Naomi Wolf, became a public figure with her first book, The Beauty Myth published in 1990, and was hailed as a next-generation feminist.

Later, Wolf went down a different path, which became especially distinctive during the Covid pandemic, when she endorsed views that, to Klein, seemed absurd and dangerous. Wolf started supporting what are conventionally called right-wing views, like gun-owners’ rights.

            People saw public statements by Wolf and unintentionally attributed them to Klein. This caused Klein to have strange feelings, as if Wolf were her evil twin, saying things she abhorred. Klein became fascinated and, with her usual energy for in-depth study, began exploring everything she could find about doppelgängers, including mythology, psychological analyses and fiction. There are novels and films about doubles. A well-known example is Oscar Wilde’s novel The Picture of Dorian Gray, in which a man retains his youthful looks while a painting of him, hidden away, ages instead. Klein probed many such stories, looking for insights into her own situation.

            Doppelganger is a long book. After writing best-selling books focusing on big issues like capitalism and climate change, it might seem self-indulgent to analyse a personal issue about an apparent real-life double. When there are so many pressing concerns in the world, ones for which Klein has well-developed capacities to explore, why bother with a seemingly trivial matter?

            Well into Doppelganger, Klein provides answers to this question. She finds the presence of doubles in ever wider facets of human life. She gives special attention to Covid. As noted, Wolf, during the pandemic, promoted some unorthodox ideas. Klein, in contrast, pretty much adhered to the standard line, conveyed by medical authorities, about lockdowns, distancing, masks and vaccines. To Klein, it seemed that Wolf was a mirror image of herself, adopting views that were an evil inversion of her own.

            But Klein, ever critical of her own thinking, wondered whether her mirror self had something to offer. By rejecting entirely any challenge to orthodox views about Covid, was something being lost, some insight into the dominant position? This is a crucial question for Klein and for the reader, and I think it’s an important one. But before addressing Klein’s big-picture examination, there’s one aspect of her treatment of Covid I need to mention.

Covid matters

Klein, by adopting the authorities’ position concerning Covid, is able to position Wolf and other Covid critics as delusional and dangerous, putting their own freedoms above the health of others. Klein sees this as individualism, a feature of neoliberal society, running rampant over collective concern about everyone’s welfare. But there is another way to frame this clash of worldviews.

            Throughout the pandemic, not all dissident views prioritised individual rights over collective welfare. Consider, for example, the Great Barrington Declaration, initiated by three accomplished medical researchers and signed by hundreds of thousands of health professionals. They supported protecting the vulnerable, the aged and the immune-system compromised, while letting Covid spread among the young and healthy, to whom it posed little threat. The young and healthy would develop natural immunity, which comes from having the disease, and could then safely contact the aged and infirm.

            Klein does not mention the Great Barrington Declaration, nor that its leading figures came under fierce criticism and were censored. For the purposes here, there is no need to examine the pros and cons of the declaration, only to note that Klein’s contrast between community-minded Covid orthodoxy and individually selfish Covid heterodoxy can be questioned. Furthermore, Covid-control orthodoxy involved many things that separated people from each other, including lockdowns, masks and distancing. Pandemic policies were devastating for many social-movement campaigns, inhibiting collective action. Klein does not address such perspectives but instead focuses on what she sees as Wolf’s aberrant beliefs.

            When examining contentious public issues, especially ones where credentialed experts play a big role, there’s a trap involved. Such issues include pesticides, genetically modified organisms, microwaves, fluoridation — and vaccination. On such issues, establishment experts are contrasted with citizen opponents, such as Wolf, who supposedly know nothing, and it is easy to dismiss all opponents as ignorant. But on every such issue, there are highly knowledgeable dissident experts. To understand the debate, it’s necessary to delve into both science and politics rather than assuming dominant experts are right and opponents are both ignorant and wrong.


Naomi Klein


Naomi Wolf

Projection

There is a psychological process called projection that involves taking a part of your own psyche and attributing it to others, in other words projecting it onto others. For example, every person has both masculine and feminine aspects, but some men are so repulsed by their feminine side that they project it onto women — and gay men. Homophobia can be thought of as a toxic form of this sort of projection.

            There’s also a parallel process called introjection, which is incorporating another’s psychological features into one’s own psyche. Demagogues take advantage of both processes. Followers project their own strength onto the great leader, and introject weakness and dependence.

            Klein’s idea of a Mirror World is that it can be a distorted version of unwanted parts of ourselves. This is a vivid way of describing projection, individual and collective. Referring to political views classified as left or right, Klein notes that when the left drops an issue, it is sometimes taken up by the right, and then the left further distances itself from the issue. She notes that the left supported official Covid control measures due to “the torrent of lies coming from the conspiratorial right” when it should have done more questioning.

            Klein offers a low-key critique of identity politics, saying that the left, by focusing obsessively on differences and using jargon, alienates many of those outside the university set. “Moreover, when entire categories of people are reduced to their race and gender, and labeled ‘privileged’, there is little room to confront the myriad ways that working-class white men and women are abused under our predatory capitalist order.” (p. 127) Klein supports coming together in a common cause rather than asserting identities.

Genocide and Jews

Moving on from Covid politics, Klein explores other domains where doubling can provide insights. One of them is genocide. Klein tells about her experiences as a Jew, learning about the Holocaust, the Nazi genocide of the Jews, and presents a parallel between colonialism and the Holocaust, one that had been developed by a series of writers.

            When colonialists settled in “new” lands, what are now the US, Canada, Australia and New Zealand, they justified their activities as taking over empty territories, empty of people of value. In Australia, this was the legal doctrine of terra nullius, a land owned by no one. The indigenous people were treated as non-owners, so their lives and cultures could be disregarded. Today this is called “settler colonialism” because settlers took over the land and pushed out the inhabitants, in contrast to colonialism in places like India and Indonesia where Europeans ruled but did not displace the native population.

            By the time Hitler came on the scene, much of the world had been colonised this way. But Hitler had the same idea, called lebensraum, of creating land for the chosen people, the Aryans of Germany. It meant clearing the land of its existing population, of Jews and Slavs. In this way of thinking, the Holocaust was not a unique event but rather a continuation of the European colonial project, turned inwards against other Europeans rather than outward towards other continents.

            Klein offers this perspective with the added insight of doubling. Just as Indigenous people were the dangerous doubles of settler colonialists, so Jews were the dangerous doubles of Aryans in Nazi Germany.

            Then there is the question of Israel, itself a settler colonial society, in which Palestinians were killed or expelled to make room for Jewish settlers. This took place during the creation of Israel in 1948 and has continued ever since. It’s not quite the same as earlier forms of settler colonialism, but there are similarities. In Klein’s telling, Israelis, or rather Zionists, have a doppelgänger — the Palestinians whose lands and livelihoods they have taken over. And if one’s double is seen as the repository of one’s own unacknowledged bad side, one option is to attack it.

            Doppelganger was published on 12 September 2023, shortly before the 7 October attack by Hamas and the subsequent Israeli military assault on Gaza, which many informed observers have called genocide. But there was an earlier allegation about genocide of the Palestinians, during an Israeli military attack on Gaza in 2014. At this time, Klein notes, her double Naomi Wolf had spoken against the assault, using the loaded word “genocide,” and encountered a storm of abuse for such sacrilege. It was after this experience, especially during Covid, that Wolf turned to a different constituency, becoming the darling of right-wing talk-show hosts.


Rwandan genocide

            Klein ends Doppelganger with a heartfelt plea to join together with others to address the urgent problems facing humans. This might be seen as a continuation of her campaigning on climate change, but she has arrived at this point by an unusual route, one through her personal double Naomi Wolf and through an examination of doubling through art and politics.

            In her journey through doubles, Klein covers many other topics, including autism, US political strategist Steve Bannon, personal branding, conspiracy theories, digital doubles, feminism, Jew-hatred, novelist Philip Roth, and social media cancellations. She highlights the value of studying and learning from those with whom you strongly disagree. Accordingly, you need not agree with Klein at every step, or even very many of them, to learn from her journey and to apply the lessons to your own.


Not the way Doppelganger ends

Brian Martin
bmartin@uow.edu.au

For useful comments, thanks to Anu Bissoonauth-Bedford, Jungmin Choi and Erin Twyford.

A Covid cure?

Could ivermectin have ended the pandemic?

The official story on ivermectin. It’s a horse dewormer. There’s no evidence that it’s effective for treating Covid. It’s dangerous. The only people advocating it are loony right-wingers, conspiracy theorists. It should not be used. Only trust medical authorities. They say it’s no good.

            Ivermectin is toxic in another way: anyone who thinks it should be taken seriously as a possible treatment for Covid is suspect. They are deluded. In fact, just by discussing ivermectin, they harm public health by raising doubts about health authorities.

            So by treating positive claims about ivermectin seriously, I’m taking a risk of contributing to the spread of dangerous misinformation.

            Okay, I’m taking the risk. I read The War on Ivermectin by critical-care physician Pierre Kory, and I’m going to say a bit about the book. Kory tells a story so contrary to the official line that it is like entering an alternative reality, one in which health authorities turned away from a cheap, safe drug that could have ended the pandemic and saved millions of lives, indeed a drug that did save millions of lives in parts of the world where it was used extensively.

The Kory story

Medical authorities and the mass media denounced Kory when he publicly challenged the official Covid line, but for many he is a hero, fighting the establishment. I haven’t read all the research papers addressing ivermectin and other treatments for Covid, so I’m not proposing to offer an authoritative evaluation of Kory’s claims. Instead, I will just summarise some of his views and, based on my study of the politics of medicine, comment on whether I think these views are outlandish — or plausible. If Kory’s views are potentially correct, the attack on ivermectin may have enabled one of the greatest medical disasters ever.

            Kory was an emergency care physician, working in the US, handling the most acute cases in crisis conditions. Before Covid hit, he was involved in using intravenous vitamin C for sepsis, following the finding by Paul Marik, a leading figure in critical-care medicine. Discovering an effective treatment is one thing.


Paul Marik

More difficult is convincing practitioners and authorities, and Kory helped win allies to promote intravenous vitamin C.

            In this story, there’s something important to remember later. Doctors regularly prescribe drugs “off-label” when a drug is approved for one condition but is found useful for others. It’s not only legal to prescribe drugs off-label, it’s quite common. For example, doctors might note that a drug approved for heart problems is effective against migraines and prescribe it for migraine years before regulatory approval.

            At the beginning of the pandemic, Kory was one of many doctors putting heart and soul into treating patients on the frontlines, conferring with doctors internationally, learning everything he could about Covid, and especially searching for treatments. He helped form a group called the Front Line Covid-19 Critical Care (FLCCC) Alliance. The group posted a protocol for early treatment of Covid using methylprednisolone, vitamin C, thiamine, heparin, melatonin, zinc and vitamin D. Doctors using the protocol had great results, but the medical establishment and mass media showed no interest.

“The first six months of the FLCCC [in 2020] certainly resulted in better outcomes for many patients, but little did we know that we were teetering on the brink of a revolution. Paul was about to identify ivermectin, an inexpensive, incredibly safe, generic, repurposed drug as an immensely effective and potent therapy against SARS-CoV2. It was a discovery that could and should have saved lives and ended the pandemic — if not for one major problem: Repurposed drugs like ivermectin are generally off-patent, which means the manufacturer has lost exclusive marketing rights. In other words, competitors can make and sell dirt-cheap versions.” (p. 90)

            To cut a long story short, there was more and more evidence that ivermectin was effective against Covid, so effective that it was almost a miracle cure when used early and with strong enough dosages. Patients who were extremely sick recovered quickly. And there was other information. Places where ivermectin was introduced population-wide saw dramatic falls in Covid morbidity and mortality.

Opposition

Many medical authorities, it seemed, didn’t want to know. Rather than enthusiastically exploring possibilities for using and studying ivermectin, some hospital administrators refused to allow it to be used. A common argument was that the drug shouldn’t be offered until it had been proven effective in randomised controlled trials (RCTs).

            Kory kept a record of evidence, and co-authored a paper showing ivermectin’s effectiveness, including evidence from RCTs. He thought the evidence was overwhelming, and that ivermectin was so effective against Covid that it would end the pandemic then and there.

            The opposition grew stronger. There was hostile media coverage and official statements condemning ivermectin. Kory and others were dismissed from their positions. There was a publicity campaign to discredit ivermectin, introducing the label “horse dewormer.”

            Pharmaceutical companies ran their own RCTs, which showed limited benefits from ivermectin. Kory and others examined these studies and discovered serious flaws. For example, the dosages of ivermectin used were too small, or treatment was started too late. However, each negative RCT received saturation media coverage, while critiques of these studies, and RCTs supporting ivermectin, were ignored by the media.

            What was going on? For Kory, this was the most amazing thing he had ever seen. Here was a cheap, safe drug that seemed to work amazingly well against Covid, yet it was attacked, and so were those who advocated it. It even got to the stage that when doctors prescribed ivermectin for patients, some pharmacists refused to fill their orders, something Kory had never encountered in his career.

            When hospital administrators refused to allow patients to access ivermectin, an attorney named Ralph Lorigo took them to court, winning half the time. Kory reports that of 40 cases that Lorigo won, only 2 of the patients he represented died; of the 40 cases he lost, 39 of the patients died.

            The easiest explanation for the attack on ivermectin was that big pharma shaped the entire response to the pandemic. Pharmaceutical companies stood to make billions of dollars from expensive drugs and from vaccines. This massive income stream was in jeopardy if there was a cheap and safe treatment, so it had to be discredited. Big pharma has penetrated hospitals, medical associations, governments, media and tech companies, all of which acted to shut down ivermectin and its advocates.

A revealing table

One table in the book especially impressed me. It lists all the treatments for Covid ranked by treatment benefit. Here I only list a few illustrative items from the table.

ivermectin, 62%, 95 studies, $1
Casirivimab/imdevimab, 52%, 27 studies, $2100
Bamlanivimab/etesevimab, 51%, 15 studies, $1250
diet, 48%, 24 studies, $0
vitamin D, 36%, 109 studies, $1
Paxlovid, 34%, 28 studies, $529

The percentage figures indicate the estimated treatment benefit, 62% for ivermectin (higher is better). The next figure is the number of studies on which the benefit estimates are based, 95 for ivermectin. The final figure is the cost of a full course of treatment. Now guess which items from this list were recommended by the US government during the pandemic. Yep: Casirivimab/imdevimab, Bamlanivimab/etesevimab and Paxlovid. The same pattern holds for the full table. Only high-priced therapies were recommended, with one exception, acetaminophen, whose treatment benefit is negative, -28%.

Is it plausible?

The War on Ivermectin is filled with information, though with two weaknesses: there is no index and all the references are in the form of URLs. Even so, it is not hard to track down sources for most of the points covered.

            The book is also Kory’s personal story, well told in part due to co-author Jenna McCarthy. It is filled with Kory’s rage and anguish: his rage at the forces blocking a treatment for Covid and his anguish over the people who died unnecessarily.


Jenna McCarthy

            But are Kory’s central claims plausible? I haven’t studied the original articles in medical journals, for example to assess Kory’s claim that RCTs showing ivermectin is ineffective were flawed. However, I can assess some of the general claims that underpin his arguments. These are shocking enough.

1. Big pharma corruption To believe that Kory might be right, it is necessary to accept that large pharmaceutical companies are so corrupt and unethical that they will promote their own products and attack cheap alternatives at the expense of large numbers of lives. Some people just can’t accept this, but it’s plausible to me. One revealing bit of evidence is that many of the companies have been fined billions of dollars for illegal actions. Kory cites a book by Peter Gøtzsche, Deadly Medicine and Organised Crime.

Gøtzsche gives extensive documentation of corrupt behaviour by big pharma, and it is eye-opening. I read it and wrote a blog post about it. I had also read Sergio Sismondo’s book Ghost-managed Medicine, which offers a close-up account of big-pharma manipulations, and was so impressed that I wrote a review of it. With this background, believing there could be more criminal behaviour during the pandemic is not a stretch.

2. Fiddling RCTs Kory alleges that six important randomised controlled trials of ivermectin were fudged to give negative results. It is shocking to imagine that companies, and the researchers who work for them, would traduce scientific principles to obtain a desired result. This is shocking for anyone who believes scientists operate on a higher ethical plane than other mortals, but it was not surprising to me, having studied bias in science since the 1970s.

            Ben Goldacre wrote a book, Bad Pharma, in which he described the many ways in which companies manipulate research to give desired results. Reading Bad Pharma, and other similar accounts, gives reason to believe pharma-run ivermectin RCTs might have been fiddled.

3. Mass media partisanship Kory says the US mass media trumpeted every pharma RCT showing ivermectin was ineffective, while ignoring evidence that it is effective. How could the mass media — including prestigious outlets such as the New York Times — be so one-sided? This was no surprise to me. Critiques of the mass media abound, especially of the US mass media. For several years, there was even a magazine titled Lies of Our Times — I subscribed to it —with critical analyses of stories (and the absence of stories) in the New York Times and other US media. You can also turn to Project Censored for media analysis.

            Given the power of the pharmaceutical industry, with its vast profits and sway over the media, mass media partisanship during the pandemic was only to be expected.

4. Censorship Kory tells about having YouTube videos taken down and a host of other actions taken to silence anyone questioning the government line on Covid. There is a large body of evidence for this sort of censorship. I wrote about it, and a group of us reported on interviews with scientists and doctors who were censored. With the release of the Twitter files, more evidence has become available. Kory’s stories of being censored are typical features of this wider picture.

5. Neglect of generic drugs There is plenty of evidence for the neglect of cheap alternatives to drugs. One example is exercise as a way of addressing depression. Many studies show that exercise is just as effective against mild and moderate depression as antidepressants, and furthermore has beneficial side-effects — physical health — rather than negative ones. Yet this finding, rather than being trumpeted by the media and in medical circles, receives relatively little attention. Initially during the pandemic, evidence for the effectiveness of ivermectin was ignored. As Kory recounts, a full-scale attack began when ivermectin began to gain attention.

6. Political retractions When a scientific paper is exposed as fraudulent, for example based on manufactured data, journal editors may withdraw it. It is “retracted” and usually this means it is discredited. Just being wrong is not considered a sufficient reason for retraction, because many if not most scientific papers are wrong. However, in recent years, there has emerged a new sort of retraction, not because of fraud or gross error but because of hostility towards a paper based on disagreement with its findings. Sometimes there is a pretext for such retractions, such as conflict of interest, but these sorts of retractions are quite different from the usual sort. Kory’s claim that retractions of papers supporting ivermectin were unwarranted is compatible with evidence for “political retractions.”

7. Guilt by association One of the most effective attacks on ivermectin was to label it a horse dewormer. This is an example of guilt by association, in which a person or thing is stigmatised by being linked to something with negative connotations. Another example is claiming that scientists advocating ivermectin are right-wing. Kory says he and most of his FLCCC colleagues are liberals politically, yet the only media willing to report on their findings were identified as right-wing. By this association, Kory thus was tarred as right-wing. Ivermectin was caught in US left-right political polarisation.

Conclusion

The War on Ivermectin presents a shocking story. If we are to believe Kory and others in FLCCC, the actions of the pharmaceutical company and its allies — including medical authorities, governments and tech companies — have allowed the unnecessary deaths of millions of people, by discrediting the use of a cheap, safe and effective treatment for Covid, a treatment that could have stopped the pandemic in its tracks.

            I examined general claims underlying Kory’s arguments, for example that pharmaceutical companies are capable of corrupt actions on a large scale. To the extent that Kory’s story seems shocking, it is because such general claims are shocking, yet for every one of them there are ample precedents. In short, Kory’s arguments should not be dismissed out of hand simply because they clash with widespread beliefs, for example that decisions by medical authorities are always in the public interest. Instead, it is worth the effort to independently assess Kory’s claims carefully and systematically. Millions of lives were at stake with Covid, and millions more may be at risk in future pandemics.

            It might seem that Kory is proposing there is a giant conspiracy to serve big-pharma profits, but there is another way of thinking about the story.

The belief system in which salvation from Covid is provided by vaccines and expensive drugs can be likened to a paradigm, a way of understanding the disease and how to respond to it that shapes research priorities and policies. If you believe that only vaccines and proprietary drugs can be trusted and that “natural” remedies are inherently suspect, then claims about the benefits of ivermectin can be ignored, as they are bound to be bogus or, worse, they may discourage people from being vaccinated. This belief system serves the interests of big pharma, but it does not mean those who subscribe to it are consciously conspiring to hide the truth.

            Kory was previously an uncritical believer in the standard view of medicine. Pursuing the wellbeing of his patients led him into an alternative reality in which everything he thought he knew about medicine was turned on its head. He has provided his story so readers can decide whether to venture into this alternative reality.


Pierre Kory

            There is much more to The War on Ivermectin than I’ve been able to cover here, including hospital power plays, mass media bias and the politics of vaccination. One highlight is Kory’s account of the founding and operation of FLCCC in the face of powerful opposition. If you plan to help organise a challenge to a ruthless opponent during an emergency, you can learn a lot from the FLCCC’s methods and efforts. Just be prepared to lose your job and be labelled a conspiracy theorist.

Brian Martin, bmartin@uow.edu.au

Thanks to Tonya Agostini, Kelly Gates, Kurtis Hagen, Anneleis Humphries, Julia LeMonde, Susan Maret and Erin Twyford for helpful comments. None of them necessarily agree with Kory’s views or my own.

Trans dilemmas

Is it possible to support trans people but question gender identity theory?

            Several years ago at the University of Wollongong, the Ally Network was set up. It is about supporting lesbian, gay, bisexual, trans and intersex people, who are vulnerable to discrimination and harassment. According to the network’s webpage, “An Ally Program sets out to develop a visible network of empathetic people who are allies of students and staff who are gender, sex and sexuality diverse people.”

            Members of the network received information and brief training and then made themselves known by posting stickers on their office doors. Anyone identifying as LGBTI could consult an “ally” in the network to talk about concerns and to find support if they requested it. Similar networks were set up at universities across the country.

            I thought this was a valuable initiative, and joined when the UOW network was set up. I learned a lot by attending workshops and reading the detailed information provided, including the distinctions between the identities referred to by the letters LGBTI, which soon became LGBTQ+, with Q for queer and the plus sign indicating other identities. Hundreds of staff members joined the Ally Network, and there are student members too, though I haven’t heard much about any of them being contacted for support. Maybe this doesn’t matter. One of the most important functions of the network is holding public activities in support of LGBTQ+, for example holding stalls on open days and a ceremony when rainbow stairs were officially launched.


Rainbow stairs at the University of Wollongong

Dissent

While opposing harassment and discrimination against LGBTQ+ people, I also had another role. For decades I have been researching and writing about suppression of dissent, for example the silencing of critics of nuclear power, pesticides and fluoridation, among many others. This is closely connected with support for whistleblowing, which refers to speaking out in the public interest, typically by employees raising concerns about corruption and dangers to the public. Dissenters and whistleblowers encounter similar sorts of adverse actions, including censorship, character assassination, harassment, and loss of jobs.

            Dissent and whistleblowing can occur in just about every domain you can think of. I’ve talked with teachers, police, public servants, corporation employees, researchers, soldiers and members of churches, all of whom have suffered reprisals for speaking out and challenging dominant viewpoints or vested interests. In some controversies, like climate change, there are attempts from both sides to silence opponents.

Dissent and trans issues

So, what about dissent and whistleblowing on the trans issue? I learned about this from my friend Isla MacGregor, who lives in Tasmania. Isla and I have worked together on dissent issues since the 1990s, for example organising a conference on it. In recent years, Isla has become involved in the trans debate, supporting free speech and supporting critics of trans rights activists’ claims about science and law. Isla told me about how she was deplatformed from public forums in Hobart and about attempts to ban a forum she was helping to organise.

            From Isla and other sources, I learned it is risky to question gender identity theory, and risky to question whether adolescents should be affirmed in their gender preferences. To do this makes one liable to be labelled a TERF, a trans-exclusionary radical feminist. This label is the opposite of a compliment. Other labels applied include bigot, hater and Nazi.

            There are two issues involved here. One is discrimination against and harassment of trans people, which is extremely serious in many parts of the world, even deadly. I take for granted that this should be opposed.

            My concerns here are about a different but related issue, free speech and open debate on the tension between trans rights and women’s rights. In some places, especially where there is official support for trans people, there can be hostility in some circles to anyone who openly questions certain trans-related positions.

            On issues of social importance, I believe it is valuable to be able to discuss a range of views, including ones that are stigmatised. For example, it’s possible to support free speech for vaccine critics without necessarily agreeing with them. As I wrote in “Censorship and free speech in scientific controversies,” “In some cases, campaigners seek to censor opponents, most commonly on the grounds that their views are false and dangerous.” I concluded,

“The impulse to censor is often stimulated by worthy objectives, including improving public health. However, on both principled free-speech grounds and pragmatic considerations, it may be better to welcome open debate and to treat audiences as capable of assessing evidence and arguments and making informed judgements.”

Sex and gender

Decades ago, when I first learned about feminism, the standard idea was that sex is determined by genetics and gender is socially constructed. Someone with XX chromosomes is biologically a female, but they might express themselves in typically masculine or feminine ways, depending on their upbringing and social conditioning and expectations.

The problem was that biological females were rigidly channelled to conform to the female role, and biological males were rigidly channelled to behave like stereotypical men. The feminist movement challenged this, with some feminists wanting to abolish gender and others saying gender could be more fluid. With different social influences and different conditioning, a person could express sex role stereotypes different from their biological sex, and this was okay.

            There is now a different story, but I didn’t know much about it, having not explored the ideas. So when I saw a new book by Kajsa Ekis Ekman about gender theory — On the meaning of sex — I thought it would be an opportunity to learn more about it and to better understand what is driving attempts to silence critics. Ekman is Swedish and uses many examples from Sweden, plus ones from the US and a few other places.

On the meaning of sex

According to Ekman, spokespeople for gender identity theory (GIT) say gender is not connected to sex, but they don’t agree on how to define gender. If gender is innate, as GIT says, there’s no way of examining the brain to find out what it is. So how is one’s gender determined? The answer, according to Ekman’s account of GIT, is to look at behaviour. A boy who likes playing with dolls and wearing dresses is thought to be more stereotypically female while a girl who is boisterous and plays with trucks is thought to be more stereotypically male.

            The trouble with this way of determining gender identity is that it relies on stereotypes of masculine and feminine. In the old days (and still today), many children were expected to behave according to sex role stereotypes, in order to make gender expression conform with their sex. With the new world of GIT, children are encouraged to modify their bodies to conform to their personal sense of their own gender. It turns out to be a new way to discourage people from behaviour deviant from sex stereotypes.

            Ekman does her best to extract the core ideas of GIT from writing by its supporters and, in doing so, exposes what she thinks are deep contradictions. According to GIT, gender is the essence of a person and sex is irrelevant, and each of us is the best judge of our own gender. If I say I am a woman, then I am. But then there is the curious label cis. A person who is cis — a cis-man or cis-woman — experiences their gender being in agreement with their bodies. Cis is the converse of trans. But if biological sex is no longer of importance, how can someone be labelled cis? Only by looking at chromosomes. This is what leads Ekman to say GIT smuggles in biology by the back door.

            With self-identification of gender, it’s possible to call oneself trans. Someone born male can become a transwoman; someone born female can become a transman. But, according to Ekman, you are not permitted to call yourself trans if you are cis.

“It has become taboo to say ‘woman’ if one means only biological women, yet there is now a different word to refer to this group, one with the obligatory prefix ‘cis’, which equals privilege. Thus, according to gender identity theory, it is only possible to speak of the group biological women as a privileged group.” (p. 234)

            Ekman argues that conservatives and progressives agree about one thing: sex and gender identity should be aligned. Conservatives want sex to determine gender identity whereas GIT seeks alignment by having gender identity determine sex. Tomboys and effeminate boys are targets for change, either their behaviour or their bodies.

Clashing views

There are many issues concerning women’s versus trans rights. Some of them have straightforward solutions, albeit costly. What about toilets and changerooms? Should trans people be allowed in? In particular, should transwomen who have made no attempt to change their appearance or bodies be welcome in women’s toilets and changerooms? One way to sidestep this contentious issue is to convert all multi-user facilities to numerous separate ones available for just one individual at a time. (To be clear, I’m not talking about unisex facilities that have several stalls within a single large room; I’m referring to completely independent units, like at some large Sydney railway stations.)

            There is no such solution for the most vexing issue: hormone treatments for children who have a gender identity different from their birth sex. In a few cases, feelings of being in the wrong body emerge persistently from a young age. I think of the famous whistleblower Chelsea Manning, who describes this experience in her memoir Readme.txt.


Chelsea Manning

            However, in some individuals, such feelings emerge suddenly, often around puberty. When a 13-year-old tells their parents that they are distressed about their bodies not matching their sense of gender identity, and want to change, what should be done? It used to be that the more common change was from male to female, but now the reverse is more common: adolescent girls who request to be boys. At clinics where gender affirmation is the protocol, such girls might be sent to a psychiatrist and an endocrinologist and then put on puberty blockers. Some parents support this but others are concerned about their children making life-changing decisions without greater investigation and warnings.

            Ekman highlights an impact of puberty blockers that is not well publicised: some of the changes are irreversible, and sterility is a common consequence of the drugs used. Other problems include sexual dysfunction, depression and osteoporosis. Another thing: going on drugs to change one’s gender requires taking the drugs ever after, for a lifetime. How many adolescents have the maturity to make life-changing decisions with such wide-ranging consequences? Ekman notes that “The age limit on voluntary sterilisation for the general public is 25 for this very reason — not even at the age of 18 are our brains sufficiently developed to contemplate the consequences of such a decision.” (p. 138)

            Given the money involved in lifetime drug treatment, it is perhaps no surprise that pharmaceutical companies are involved. Ekman notes that trans rights have progressed far more rapidly than rights for women or homosexuals. She thinks the difference is the money to be made in transitions.

            There are so many topics covered in Ekman’s book — including women’s sport, male violence, suicide threats, intersectionality and hate speech — that I can only mention a few. One of the most important is her view that GIT and trans issues are a way for patriarchy to enter by the back door, with restrictions on women’s rights gaining support among progressives. With this way of thinking, attempts to denigrate and silence critics of GIT are a politically correct way of attacking radical feminists.

            Ekman says most of the debate is about the right of transwomen to enter women’s spaces, with hardly anything said about the rights of transmen. Indeed, transmen seem to be invisible in much of the commentary about trans issues. Recently, I read a commentary in defence of trans rights. Transwomen were mentioned ten times, transmen not at all. In sport, all the attention is on whether transwomen can compete in women’s events and teams, with no attention to transmen entering men’s events and teams. Ekman says there is no effort to adjust rules to enable transmen to succeed in men’s sport.


Kajsa Ekis Ekman

            Well, I could go on, as there is much more in On the Meaning of Sex. But what I would like to see is a calm response to the book by defenders of GIT and self-identification, laying out points of agreement and disagreement. My concern is less about trans issues and more about there being a fair and open discussion, without attempts to denigrate and silence opponents.

            I started out by asking whether it’s possible to support trans people while questioning gender identity theory. Surely the answer should be yes.

Acknowledgements Several individuals read drafts of this post and gave me valuable comments, from different points of view. Because of the sensitivity of the topic, I am not naming any of them, but I do appreciate their engagement and concern.

Brian Martin, bmartin@uow.edu.au

Future sports

Most popular sports today were created in an earlier era, and by all rights should be obsolete. Some sports, like archery, shooting and the javelin throw, have hunting connections. Many others emphasise physical strength, skill, speed and endurance. Think of weightlifting and swimming. Team sports like football reflect the importance of coordinated action, which is vital on the battlefield. Coordinated action remains important in contemporary life, for example in numerous offices where teams of workers seek to outdo competitors.

            Elite sports also attract spectators, an important function especially when entertainment is tied to marketing.

Despite these functional connections between sport and society, it is curious that so few sports give priority to skills needed to survive and thrive in a world in which mental skills are a central feature. Consider a few new sports inspired by contemporary life.

Congestion challenge Contestants sit in their cars, wired up to monitor their brain waves, and spend hours in a heavy traffic scenario specially engineered to provoke road rage. The winner is the person who can maintain the most stable brain waves while simultaneously negotiating the traffic in a skilled manner, as judged by an artificially intelligent (AI) driving-skill monitor.

Question dodging Contestants ask each other challenging questions. Answers are judged according to how successfully they avoid giving a straightforward answer. Two or more can play, each asking questions and dodging the questions they are asked. Rambling responses receive a low score, whereas responses that seem plausible while having little substantive content are scored highly, by an independent panel. Laughing leads to disqualification. Career politicians are excluded as having an unfair advantage.

Shopping marathon This is a competitive enactment of “shop till you drop.” Contestants are given a credit limit and then must shop continuously for as long as possible, finishing when they spend their last cent. Most events last for days, during which time no food is allowed, only water. Keeping eyes shut for more than a few seconds is not allowed.

Sit-out Two dozen contestants sit at desks in a room facing the front and listening to a speaker. Each contestant is monitored for physical motion and brain waves. The winner is the person who remains awake and maintains focus on an incredibly boring speech, with calm and natural body motions and no tensing of muscles throughout the body.

Smile-a-thon Contestants must maintain a smile and associated positive body language while being exposed to rudeness, verbal abuse and absurd behaviour. They take turns trying to disturb the smiles of other contestants. Smiling authenticity is judged by an independent panel supported by AI.

Binge-watch This is an endurance event. Contestants watch a boring show on a screen while their brain waves are monitored. Beta waves must be maintained, and even a short period of sleep or daydreaming means disqualification. Body movement incurs penalties. The event continues until only one contestant remains.

Kafka challenge Contestants have to negotiate bureaucratic regulations that change in an unpredictable pattern designed to prevent the completion of an assigned task and to generate frustration. To win, it is necessary to keep going longer than any other contestant. Some games last for weeks or months. Psychiatrists are at hand to treat psychological injuries.


Franz Kafka

The new frontier for competitive endeavour is mental rather than physical. Using muscles is very much the old paradigm, suitable for when farm and factory work predominated. Today, in a post-industrial society, mental and emotional capacities are more valued, so it is only appropriate that sports encourage and recognise extreme ability in these domains.

            You might think new sports like these would not be entertaining, but there is great scope for dramatising ordinary actions. Reality television paved the way for the entertainment value of dull everyday activity. There are endless possibilities for close-ups of faces, brain-wave monitors, contestants who drop out or crack up, interviews with contenders, and commentators giving opinions about the course of the competition. After all, many physical sports are either incredibly slow, like cricket, or incredibly repetitious, like tennis. Spectators are attracted by the contest. Who, after all, watches reruns of last year’s events?

            Future mental-emotional sports will be just as exciting as old-style muscle-based ones and will lead to new sporting celebrities, valued for their minds rather than their bodies. Just think how many children will be inspired by these celebrities to practise for years to develop their minds. Rather than perfecting a golf swing, the next frontier is mind control.

Brian Martin, bmartin@uow.edu.au

Postscript

Just to be clear, this is a satire. Actually, I’m a critic of elite sports (while admiring the athletes), especially the Olympics, and support participation in cooperative games.

            Thanks to Aloysia Brooks, Sharon Callaghan, Suzzanne Gray, Tim Johnson-Newell, Olga Kuchinskaya and Yasmin Rittau for valuable feedback. Sharon and Yasmin pointed to present-day versions of some of these “future sports,” and noted that they can foster valuable skills or undesirable behaviours, or both. So far, though, there are no world championships for any of these mental sports. Meditation may be good for you, but should it be a competitive event?

A message from the Turtles

A new book offers the best available critique of vaccination orthodoxy. 

(This is a long review. To skip the preliminaries, go to “Turtles enter the fray.”)

The vaccination debate

In 2010, I began writing about the vaccination debate — the public debate over the benefits, risks, ethics and politics of vaccines. This was long before Covid-19, so nearly all the debate was about childhood vaccines for diseases like polio, measles, diphtheria, and tetanus.

            I came to this issue having previously written about disputes over nuclear power, pesticides, fluoridation, nuclear winter and the origin of AIDS. In the field of science and technology studies or STS, these are called scientific controversies. They typically involve striking disagreements between both scientists and laypeople, and aren’t just about science. They also involve disagreements over ethics, decision-making and values such as freedom.

            In studying the vaccination issue, my purpose is not to take a side but to understand the dynamics of the controversy, including the players, their moves and claims. I also have another purpose, which I’ll come to.

            There are remarkable similarities between different scientific controversies. They typically pit a powerful establishment, supported by governments or corporations and most experts, against citizen opponents, backed by a small number of dissident experts. This at least is the configuration in debates over nuclear power, pesticides, fluoridation, genetically modified organisms, microwaves — and vaccination. There are two important exceptions, where most experts oppose a powerful establishment: smoking and climate change.

            In every controversy, it is possible to examine public campaigning and expert scientific commentary. In public campaigning, it is common to find mistakes, exaggeration, misunderstandings and misinformation. However, judging what is a mistake is not always easy, because partisans on one side or the other may challenge what seems like an obvious statement or assumption. For example, I refer to the “vaccination debate” but some proponents say there is no debate and any disagreement with vaccination is misinformed or worse.

            Before proceeding, I had better explain my own position. I do not have strong views in favour of or opposed to vaccination. As noted, my interest in the issue is as a social scientist, to learn about the way the debate proceeds. My other interest in the issue is to defend free speech on controversial social issues. I believe in the value of open dialogue, discussion and debate. If vaccines are highly beneficial and extremely safe, criticism should be welcomed so that it can be clearly and accurately countered. If vaccines have shortcomings, criticism is valuable for highlighting them, hopefully leading to better products and practices.

Writing about the vaccination debate

I started writing articles about the vaccination debate, in particular about a most amazing attack on an Australian vaccine-critical group. By doing this, I came under attack myself. This was wonderful! As a social scientist studying a public scientific controversy, it is often difficult to obtain first-hand information. Social researchers usually rely on published materials, interviews and surveys, but remain separate from the action. I didn’t just have a front-row seat: I was on the playing field. Some others were treating me like a player.

            In writing scholarly articles, I gradually developed a standard way of introducing the vaccination debate in a few words. Here’s one example, from 2012:

Vaccination against infectious diseases is supported by medical professions worldwide (Andre, et al., 2008; Offit and Bell, 2003), and in most countries there is a standard set of vaccinations given to children. In the face of this medical orthodoxy, a small number of citizens’ groups and professionals present a contrary position, arguing that the benefits of vaccination have been overestimated and that there are significant risks to individuals and society, with recorded cases of seriously affected children (Habakus and Holland, 2011; Halvorsen, 2007).

You can see that for the vaccination-positive view, I gave two references, and likewise for the vaccine-critical view. In each case, I wanted to give solid, credible references. Reflecting on how I proceeded, my implicit criteria were that the source should be comprehensive, reasoned, authoritative and readable.

  • Comprehensive: the source needs to address all or most of the vaccines and the scientific and medical issues in the debate.
  • Reasoned: evidence and arguments should be presented in a careful, logical, systematic way.
  • Authoritative: the authors and the content should be credible.
  • Readable: the writing should be understandable by non-experts.

It’s hard to satisfy all these criteria. For example, there is a vast quantity of vaccination-positive materials in scientific and medical journals, but most of it is specialised (not comprehensive) and aimed at experts (not readable).

Vaccination-positive sources

For the case for vaccination, the book by Paul A. Offit and Louis M. Bell was an ideal reference. Titled Vaccines: What You Should Know, it is aimed at a general audience, covers the full gamut of vaccines and comes across as informative. Paul Offit is a doctor and professor and a prominent advocate of vaccination, and Louis Bell is also a doctor. Some of Offit’s other works include bitter attacks against critics, but Vaccines does not enter this territory.

            A correspondent alerted me to an article by F. E. Andre and eleven co-authors. It is titled “Vaccination greatly reduces disease, disability, death and inequity worldwide,” and published in the Bulletin of the World Health Organization. The title alone suggests the article’s aim to be comprehensive, and the authors are a slew of experts in the field. It scores less on readability.

            Later I cited another source: Vaccines. The seventh edition of 2018 is edited by Stanley A. Plotkin, Walter A. Orenstein, Paul A. Offit and Kathryn Edwards. This is a massive text, aimed at specialists. It is definitely comprehensive, and the editors have high status in the field. It is factual rather than overtly partisan but is not bedtime reading for non-experts. It is good for pointing to the vast quantity of research supporting vaccination.

            No doubt there are other good sources. These were the ones I found most useful. My purpose was to point to credible material supportive of vaccination. I guessed that few readers would bother to look up any of these sources, but they needed to know they existed.

Vaccine-critical sources

To show the existence of a dispute over vaccination at the level of science, I wanted to cite sources that had some parallels with the vaccination-positive ones. That means ones that are comprehensive, reasoned, authoritative and readable. At this point, it is useful to note a crucial asymmetry in the debate. Because nearly all scientific and medical authorities support government vaccination policies and practices, it is unlikely there will be any authoritative critics, because to be a critic is to become a target of attacks on credibility.

            You’ll note that I’ve avoided using the term “anti-vaccination.” It is misleading, and in the shortened form “anti-vax” has been turned into a term of denigration. Anyone who deviates from the official vaccination position may be called an anti-vaxxer. This includes parents who space out their children’s vaccines or choose some vaccines but not others. It includes researchers who raise any questions or reservations about vaccination. To call someone “anti-vax” suggests they are opposed to all vaccines, which is misleading. Therefore, I avoid the label “anti-vaccination” for both its imprecision and its derogatory connotations. Although “pro-vaccination” does not have negative connotations, I’ve also avoided it.

            For vaccine-critical sources, I found a book by Richard Halvorsen titled The Truth about Vaccines.

Halvorsen is a doctor who researched the issues himself. Halvorsen is not opposed to vaccines — he gives them. But he wanted to find out the full story, and so addresses both the history of vaccination and each vaccine in turn, focusing on Britain and its policies and experiences. He provides lots of references. His message is to be aware and consider the evidence, not to make a knee-jerk decision either way. Halvorsen’s book, now in its fourth edition titled Vaccines: Making the Right Choice for Your Child, is comprehensive, reasoned and readable. It somewhat lacks authority in that he is not an established researcher in a relevant field such as virology or epidemiology.

            Another useful critical source is Vaccine Epidemic, edited by Louise Kuo Habakus and Mary Holland. It covers a wide range of issues, ranging from law and ethics to the politics of science. However, compared with Halvorsen’s book, much less of Vaccine Epidemic addresses the scientific evidence about vaccination.

            In 2018, a comprehensive critique of vaccination was published: Mateja Cernic’s Ideological Constructs of Vaccination. It is a revised and expanded version of her PhD thesis at the School of Advanced Social Studies in Slovenia. The book is an intriguing combination of massive documentation and strong statements. It includes a treatment of social aspects of medicine and vaccination, covering discourses, ideologies, representations of vaccination critics, power and abuses of power by medical and state authorities. The longest chapter is a challenge to the orthodox view about the effectiveness and safety of vaccination, covering infectious disease mortality rates, the immune system, adverse events, safety and efficacy studies, contamination of vaccines, monitoring of adverse events, and herd immunity. This would seem to be a powerful challenge, yet it has received little attention, perhaps in part because it is not so easy to read, and the author is a sociologist, someone outside the medical establishment.

Turtles enter the fray

Being on the lookout for good sources on the pros and cons of vaccination, I obtained a copy of a book published in 2022 titled Turtles All the Way Down. The title, at first glance, sounds peculiar. The subtitle is more revealing: Vaccine Science and Myth. For convenience, I will refer to it as Turtles.

            The book arrived with plenty of advance publicity. It was published in 2019 in Israel, in Hebrew, and made a splash. I read that it had received a positive review in an Israeli medical journal, a review written by Ety Elisha and Natti Ronel. Well, well. I knew them: we were collaborating, along with two others, on a paper about suppression of critics of official views about Covid-19. It’s a small world.

            An unusual aspect of Turtles is that its authors are anonymous. They chose not to reveal their identities to avoid ad hominem attacks. Also, if they worked within the health system, they could be subject to reprisals in their careers. That’s exactly what I had been studying for the past decade concerning vaccination, and even longer for other scientific controversies. Remaining anonymous makes a lot of sense to me. Indeed, it’s what I recommend for whistleblowers, whenever possible. The authors call themselves The Turtles Team or TTT.

            Turtles is a frontal attack on the assumption that the standard childhood vaccination programme is both safe and effective. This assumption is at the core of the vaccination paradigm, the framework that guides thinking and research in the area.

            To illustrate the contrast between TTT’s analysis and the official position on vaccination, I found a short article that nicely articulates the orthodox view, an article you can read yourself. Titled “Simply put: vaccination saves lives,” it was published in 2017 in PNAS, the Proceedings of the National Academy of Science, a prestigious long-standing US scientific journal. The authors are Walter Orenstein and Rafi Ahmed, both from Emory University. Orenstein, from the Department of Medicine, is also one of the four co-editors of the text Vaccines, which I mentioned earlier as an authoritative source for the vaccination-positive view. I will refer to Orenstein and Ahmed’s article to highlight assumptions and emphases in the orthodox position on vaccination, the position challenged by the Turtles Team.

Safety

Let’s start with safety. Orenstein and Ahmed do not explicitly discuss adverse events caused by vaccination, but instead implicitly dismiss them by countering concerns that vaccines cause autism. Perhaps their assumption is that if the autism claims don’t stand up, less well-known ones won’t either.

            A prime claim in Turtles is that the safety of standard vaccines has never been established, indeed that assumptions or claims about safety have no foundation. How could this be? TTT begin by examining the vaccine approval process and the randomised controlled trials that are required, clearly and carefully explaining what’s involved. In phase 3 trials, there are two groups of children. One group is given the vaccine, let’s say a vaccine for chickenpox, and the other group is given a placebo: they are injected with a passive or neutral substance. No one, including the researchers and the children, is supposed to know which children get the vaccine and which get the placebo. When testing for safety, the numbers of adverse events — including seizures, breathing difficulties, allergic reactions, paralysis, severe illness and death — in each group are noted. If the frequency of adverse events in the vaccine group is not much higher than the frequency of adverse events in the placebo group then, after other factors are taken into account, the vaccine is assessed to be safe.

            The problem, TTT say, is that the placebos in phase 3 trials of childhood vaccines, before they are licensed for use, are not inert. The researchers doing the safety studies could have used a saline solution for the placebo, but instead they use other vaccines. This would be fine if the other vaccine had been shown to be totally safe but, according to TTT, no vaccines have been tested against inert placebos, and hence the clinical trials don’t actually show how safe the vaccine is. This is a striking claim, and also a daring one given that a single counterexample, a single study, might undermine it. A safer claim by TTT would be that despite extensive searching, they have not discovered a phase 3 trial of a vaccine against an inert placebo.

            Note that TTT don’t make a detailed claim about the rate of adverse events. They just say the clinical trials haven’t shown vaccines to be safe. As they put it, “The true rate of adverse events of routine childhood vaccines is virtually unknown; therefore, there is no scientific basis for claiming they’re safe.” (p. 66)

Undone science

Clinical trials are only one way to examine the safety of vaccines. Another possibility is to undertake biological and physiological research into adverse events. TTT examine studies in this area, or rather their absence. Their conclusion is that the generous funders of vaccine research — there is a vast amount of research in the field — seem remarkably averse to adverse-events research into diagnoses, causal mechanisms, individual susceptibilities, and therapies. By not undertaking studies to better understand damage from vaccination programmes, it remains possible to say vaccination is safe.

            David Hess, an anthropologist and sociologist at Vanderbilt University, and my friend and collaborator, introduced the idea of undone science. This refers to research that could be done, and furthermore that citizen activists say should be done, but which is neither funded nor carried out because the findings might be unwelcome to powerful groups with vested interests. There are many examples, especially on environmental and health topics. For example, the sweetener mannitol may have benefits for treating Parkinson’s disease, but because mannitol cannot be patented, companies didn’t want to research it.

            TTT do not refer to Hess’s analysis of undone science. The team sticks to scientific and medical sources and does not engage with social-science writings. Nevertheless, the team’s examination fits the picture of undone science perfectly.

            What about the reporting of vaccine adverse events? Anyone following this issue will soon hear about VAERS, the Vaccine Adverse Event Reporting System, where harmful side effects of vaccines can be reported. If there aren’t many reports, that should indicate that vaccines are safe. But, according to TTT, there’s a problem, actually several problems. Although reporting of cases of many infectious diseases is mandatory, when it comes to potential adverse events from vaccines, reporting is voluntary, and doctors are not compensated for making them. Furthermore, many doctors are reluctant to make reports, telling patients that their conditions could not be due to vaccines but are just a coincidence. This suggests considerable underreporting. Some estimates are that only one in ten, or one in a hundred, adverse events are reported.

            So why not improve the rate and quality of reporting to determine how accurate VAERS actually is? There was a study to show how this could be done but the CDC — Centers for Disease Control and Prevention, the US body charged with vaccination recommendations — stopped engaging with the researchers, without explaining why. TTT argue that the CDC has shown no interest in improving VAERS.

            TTT’s next target is epidemiological studies showing a low rate of adverse events. Imagine collecting data from a large population about the incidence of a particular condition, let’s say high blood pressure. Then collect data about people’s ages, incomes, diets and anything else you can think of that might be relevant. By looking for statistical relations between the health condition and other factors, you might be able to notice, for example, that people’s blood pressure gets higher as they get older, or that it’s higher for people who eat lots of meat, or whatever. These are correlations, but they don’t prove causation. Maybe people who eat lots of meat get less exercise: it could be that lack of exercise is the main factor responsible for high blood pressure. Or it could be the salt in the meat dishes. You can see this gets quite complicated.

            TTT provide a primer on epidemiology, explaining the basic ideas clearly and simply. They then offer a damning indictment of epidemiological studies about vaccine safety, arguing they are designed to show no correlations between vaccines and adverse events. This is serious. TTT closely examine five major studies. Based on their examination, they suggest the studies are biased by design or execution, using defective research methods, relying on unsubstantiated data, omitting essential data, making meaningless calculations, dismissing unwelcome findings and exaggerating the significance of the findings.

            Remember that Orenstein and Ahmed in their article “Simply put: vaccination saves lives” did not explicitly mention adverse events caused by vaccines, but implicitly dealt with them by dismissing a study by Andrew Wakefield and 12 collaborators about the possible connection between the MMR triple vaccine and autism. One of the epidemiological studies often cited as showing there is no such connection is by Madsen and colleagues. This is one of the “doctored” studies that TTT analyse, showing systematic shortcomings.

More undone science

TTT next examine what they call “the studies that will never be done.” An obvious way to investigate the overall safety of the entire vaccination schedule is to compare the health of two groups of children that are as similar as possible except in one respect: one group receives all recommended childhood vaccines and the other group receives no vaccines at all. Simple! Such a study would gather all the benefits and risks of vaccines, the benefits from reduced incidence of infectious disease and the risks from adverse events, and anything else, including beneficial or harmful effects not normally considered. A study like this showing the benefits of vaccination would be a powerful way to encourage parents to have their children vaccinated. But, perhaps surprisingly, such a study has never been undertaken by medical authorities. (There are some small studies by vaccine critics showing unvaccinated children have better health.)

            This is the most striking example of undone science in the vaccination arena. A plausible reason is that proponents are afraid the results might not support vaccination, or not support it as much as they hope. TTT go further, suggesting that the CDC has the data and therefore comparative studies may have been quietly done but never published because the results do not support vaccination. This is speculative. Another explanation derives from the vaccination paradigm: proponents operate within a framework that assumes vaccines are vital for health.


Historian-of-science Thomas Kuhn introduced the idea of scientific paradigms

Given this belief, there is no need for further studies to see whether vaccines are beneficial. In fact, publicity about doing such studies might generate alarm, by making people think there is some reason to doubt the vaccination programme. Within the assumptions of the paradigm, this is a reasonable concern. However, it does mean that critics can continue to point to the absence of definitive studies showing that the net benefits of receiving all recommended childhood vaccines are greater than having no vaccines at all.

            I’ve referred to the “vaccination schedule.” In guidelines for childhood vaccination, there are targets for particular vaccines at specific ages, for example, in the US, hepatitis B at birth, one month and six months. The schedule is another target in Turtles. For example, in the usual schedule, several vaccines are given in a single visit. Some parents prefer to space out the vaccines. Is there sound evidence for the safety of giving multiple vaccines at the same time? TTT say no.


A vaccination schedule

            Given TTT’s sustained critique of assumptions about vaccine safety, does this mean that vaccines are unsafe? This depends on what exactly is meant by unsafe. Despite statements that “vaccines are safe,” careful vaccination advocates always acknowledge adverse events, but say they are extremely rare. What TTT have done is show that the research behind the claim that risks are extremely low is simply not there. They show that research about adverse events is either flawed or not done at all. But what if studies were carried out to accurately determine the rate and significance of adverse events? One possibility would be that the adverse events would be shockingly frequent, validating the worst fears of vaccine critics. But another possibility is that harmful effects would be modest, perhaps higher than ones currently acknowledged but not high enough to outweigh benefits. TTT may have shown that the science of vaccine safety lacks foundations, but they haven’t attempted to show what the science would say if it did have a solid foundation. By the nature of undone science, no one can know for sure. But we do know who is resisting doing definitive studies.

Benefits

In the usual slogan of “Vaccination saves lives,” the benefits are assumed to outweigh the risks. There is a sleight of hand here in referring to “vaccination” rather than individual vaccines. It is quite possible that a group of vaccines reduces the death rate but some specific vaccines cause more harm than benefit.

            Orenstein and Ahmed’s opening sentence is “Few measures in public health can compare with the impact of vaccines.” The Turtles Team challenges this claim. They provide figures showing that deaths and illnesses from infectious diseases were in rapid decline before mass vaccination was introduced, and argue that most of the decline in these diseases was due to other measures that improved public health, including clean water, good diet, better hygiene and a higher material standard of living.

            Orenstein and Ahmed provide a table showing the decline in annual morbidity (ill health) for vaccine-preventable diseases. It shows, for example, that measles morbidity declined by more than 99%. From what? Their base figure is the “20th Century annual morbidity” which they compare to reported cases in 2016. What they don’t provide is a comparison of morbidity before and after the introduction of mass vaccination. See below for more on this.

            These arguments are not new. They were presented, most prominently, by Thomas McKeown, and have been cited repeatedly by vaccine critics. Despite this, vaccine proponents seldom mention these arguments. Orenstein and Ahmed certainly do not. I wish vaccine advocates would provide a cogent rebuttal of the work of McKeown and others who question the scale of the benefits of vaccination. So far as the public debate is concerned, this might be called an “undone refutation.”

            You can see that the slogan “vaccination saves lives” is suspect if the benefits have been exaggerated and the harms undercounted. But TTT are not finished. There is one more important claim to address.

Herd immunity

Proponents argue that being vaccinated primes the immune system, reducing the risk of catching the targeted disease. They also argue that when most people have vaccine-induced immunity, others — including people who can’t be vaccinated — are also protected. For a virus to spread, it needs to encounter susceptible hosts: others who can be infected. If most people are immune to the virus, the disease outbreak will die out. This process protects the whole population, the “herd,” a collective benefit from sufficiently high levels of immunity in the community.

            Vaccine proponents make a big deal about herd immunity. It provides a moral imperative to be vaccinated and to promote vaccination, including through mandates. Orenstein and Ahmed devote a considerable portion of their short article to herd immunity, complete with a colourful diagram.

They write that herd immunity “provides the rationale for interventions to achieve high population immunity” including “mandates for immunization requirements for attending school.”

            For years I’ve read the arguments for and against herd immunity. Vaccine proponents almost invariably raise it, sometimes at such length that people gain the false impression that the main benefit of receiving a vaccine is not to yourself but to others. The result of this impression is that vaccination is sold, and often perceived, as altruistic, which means those who question vaccination, or are not vaccinated, can be painted as selfish.

            I wondered why herd immunity plays such a high profile in arguments for vaccination but analogous concepts are less prominent concerning other public health interventions. By analogous concept, I mean the idea that health-related behaviours benefiting the individual can also benefit others in the community. The example I find most compelling concerns alcohol. Not drinking alcohol benefits one’s own health by reducing the risk of cirrhosis of the liver, pancreatitis, cancer and other maladies (partially counteracted by a few health benefits). Not drinking also reduces the harm to others caused by drunk driving and domestic violence. A community with less drinking is a healthier and safer community. There is more to be said about the pros and cons of alcohol, and I’m not making an argument for prohibition or abstention. The point is that the collective-benefit argument does not play such a big role in alcohol debates.

            Turning to writing by vaccine critics, it’s possible to find critiques of herd immunity, with arguments that it doesn’t exist or is irrelevant.

            So is herd immunity the most wonderful thing since sliced bread, or fake news? I don’t remember seeing an intermediate view — until reading Turtles. TTT systematically examine the evidence for and against herd immunity for each of 14 vaccines, from tetanus to measles. They conclude that, with sufficient coverage, five of them may confer herd immunity, whereas the others probably will not, or that their protection is not relevant or beneficial to children. It was refreshing to encounter an analysis that independently follows the evidence and doesn’t end up purely in one of the two warring camps.

Remember that Orenstein and Ahmed provided figures showing the measles vaccine reduced disease morbidity by over 99%. TTT agree that the vaccine reduced morbidity through herd immunity, though perhaps not by this percentage. Some vaccine critics may find this assessment unwelcome.

            TTT’s analysis shows the value of making careful assessments of different vaccines, each one with specific considerations and complications. Rather than follow Orenstein and Ahmed in saying “vaccination saves lives,” the question should be whether specific vaccines save lives, and beyond this who benefits and who suffers harm.

            To question vaccine-induced herd immunity is to question the rationale for coercive means to promote vaccination, for example requirements for attending school. Even for vaccines providing herd immunity, an assessment of the overall benefit needs to take into account harmful side effects. As TTT put it, “in the absence of solid evidence for a positive net benefit for individual vaccines, as well as the totality of childhood vaccination programs, there is no moral justification for mandating vaccination, or enforcing it in any other way.” (p. 367)

Polio

In 1990, I began studying the debate over the origin of AIDS. In particular, I became interested in the hypothesis that AIDS could have started as a result of contaminated oral polio vaccines used in central Africa in the late 1950s. Even if this hypothesis is correct, it says nothing about the safety of today’s vaccines, so the origin-of-AIDS debate is not relevant to the arguments in Turtles. Anyway, in the course of studying the polio-vaccine theory of the origin of AIDS, I read various studies of polio, including dissident views about its cause. One of those dissident views is that many or most cases of what we call poliomyelitis, a serious paralytic disease, are due to exposure to pesticides.

            Polio has long had a high profile, first as a disease to be feared and then as one of the great triumphs of vaccine research. In the 1950s, Jonas Salk developed a vaccine that was injected. Then Albert Sabin developed an oral vaccine, typically taken with a sugar cube. I vaguely remember having this vaccine when I was in primary school. The struggle to eradicate polio is one of the longest-running sagas in vaccination lore. As you can imagine, the idea that pesticides are the main cause is not likely to receive a warm welcome from the medical establishment.

            Turtles provides the clearest exposition of this idea that I’ve encountered. In a long chapter, TTT systematically lay out a series of open questions and contradictions in the official story about polio, presenting the standard view and an alternative explanation based on pesticide exposure. For example, they ask “Why did most of the early polio outbreaks occur in sparsely populated rural areas rather than in the large and crowded metropolitan areas?” The standard view about polio, which assumes the contagious spread of the poliovirus, cannot explain this. The alternative view gives this explanation: “Farming communities were the first to be poisoned by the use of toxic pesticides.” All up, TTT list 19 mysteries not explained by the standard view but apparently explained by pesticides being the primary factor in paralytic polio.


DDT spraying in the 1950s

            TTT’s arguments about polio are not essential to their overall critique of the risks and benefits of childhood vaccines, so their polio chapter might be thought of as a provocative supplement, an extra way of showing the limitations of establishment explanations. Without trying to get to the bottom of the polio story, my thought was “I’d really like to see vaccination proponents offer their views about each of these 19 apparent mysteries.”

What next?

In the late 1980s, I made an intensive study of the fluoridation controversy, and came to the conclusion that nothing would resolve the controversy in the short term. No matter what new evidence and new arguments are introduced, partisans on each side maintain their positions. This sort of polarised scientific controversy can be likened to a clash of paradigms, with adherents to each side seeing the world through assumptions almost impervious to new evidence. Contrary information is treated as anomalous, and supportive evidence is intertwined with assumptions about ethics and appropriate methods of decision-making.

            Why should the vaccination controversy be any different? I don’t expect Turtles to turn the tide. However, it will undoubtedly be a potent tool for vaccine critics.

            During the 1980s, US pro-fluoridationists discussed whether to engage in debates with anti-fluoridationists. Those who said yes thought that debates provided an opportunity to show the superiority of the arguments for fluoridation. Those who said no feared that engaging in debates gave anti-fluoridationists too much credibility. In essence, debating meant accepting that there was something worth debating. But there was a problem with refusing to debate: it seemed arrogant, which could hurt the cause. The debate about debating was never resolved.


Water fluoridation debate in Portland, Oregon

            These same considerations are present in the vaccination debate. My guess is that vaccination proponents will studiously avoid engaging with the arguments in Turtles. It is certainly possible that they could counter some of TTT’s arguments but, alas, we will probably never know, because proponents are in the ascendant, having cemented childhood vaccinations as an unquestioned good and stigmatised the slightest reservation or criticism.

            This is a sad state of affairs. There are a great many people who would benefit from an open debate, without ad hominem attacks, with respect for contrary views. Such a debate might lead to some backing down from vaccine mandates and more tolerance for selective vaccination and even non-vaccination. On the other hand, the debate might lead to a more solid basis for the benefits of some vaccines.

            “Debate” is the wrong word. There needs to be deliberation, a calm, rational discussion with the aim of reaching an agreed position, the sort of process used in citizens’ juries to look at all manner of contentious issues. In such a jury, a group of randomly selected citizens addresses a carefully specified issue by weighing up available evidence and reaching collectively-agreed recommendations. But allowing citizens to have input via deliberative processes is unlikely while experts and authorities are in full control.

            However, even deliberation would not be enough, because of undone science. There is too much research that needs to be carried out, too much evidence that needs to be collected, before judgements about vaccination can be put on a solid basis.

Conclusion

Of available critiques of vaccination orthodoxy, I think Turtles is the best yet. It exposes systematic weaknesses in studying the harmful effects of vaccines and challenges the usual claims about the benefits of vaccines for the individual and the community. The book has all the features I look for.

  • Comprehensive: it covers the central scientific and medical issues in the debate.
  • Reasoned: evidence and arguments are presented in a careful, logical, systematic way.
  • Authoritative: the authors, though anonymous, show their knowledge through their grasp of research and through comprehensive citations to medical research.
  • Readable: the writing is remarkably clear, and occasionally high-spirited.

            Two predictions. First, vaccination advocates will try to ignore the book. They are unlikely to engage with the book’s contents, though they might complain about the authors’ anonymity. Second, Turtles won’t end the dispute, which is likely to continue for decades.

Turtles was written before Covid and does not address Covid vaccines. Yet Covid is an important factor in the vaccination debate, because Covid vaccine mandates, and adverse events from Covid vaccines, disturbed large numbers of people, leading some to protest publicly. Concern about and opposition to Covid vaccines led to greater questioning of other vaccines. For those who are energised by concerns about Covid vaccines, Turtles is the ideal source for learning about the evidence and arguments.

Although arguments seldom resolve scientific controversies, events sometimes make a big difference. In the debate over nuclear power, the accidents at Three Mile Island, Chernobyl and Fukushima had immense impacts, serving to discredit the technology. In the vaccination debate, a major vaccine disaster could play a similar role. The full story of the impact of Covid vaccines is yet to play out, but it is reasonable to say that when promoters endorse a vaccine that is widely seen as disastrous, they jeopardise the rest of the vaccination programme. So perhaps my prediction about the continuation of the debate is off the mark. Time will tell!

            There’s much more to be said about Turtles. But enough from me, for now. You can form your own view, let me know what you think and, after you’ve read the book, contact The Turtles Team at the email address given in their book.


A different turtles team

Brian Martin

bmartin@uow.edu.au

For valuable feedback, I thank Steven Bartlett, Lyn Carson, Jungmin Choi, Kevin Dew, Bob Dildine, Kelly Gates, Anneleis Humphries, Olga Kuchinskaya, Julia LeMonde, Natti Ronel, Wendy Varney, Qinqing Xu and others who prefer to remain anonymous. None of them necessarily agrees with the views expressed in this review or by The Turtles Team.

Thinking about death

When is the last time you thought about your life ending? Did this cause distress or cheer you up? Either way, you’re thinking about your own mortality, and that can change the way you think and act on other issues. More on this later.

            When I was a teenager, I thought a fair bit about the end of my consciousness, and started reading about death. I don’t remember the names of any of the authors except for the Spanish writer Miguel de Unamuno, and don’t remember what any of them said!

            At Rice University in 1968, I had the opportunity to take a class titled “The meaning of death in Western culture.” I remember that I wrote my final essay arguing that religious arguments for immortality were inadequate and the best scientific evidence for life after death was from psychic phenomena, and this evidence was inconclusive. I was majoring in physics and I guess my scientific mindset was on display.

            In the following years, the issue of my own mortality became less salient. I still read and thought about death-related issues, for example through my studies of nuclear extinction, the euthanasia debate and Death imagined as a powerful perpetrator. Even so, I became far more accepting of the end of consciousness.

            What would it be like to go to sleep and not wake up? The best answer I discovered was in the book The Mind Club by Daniel M. Wegner and Kurt Gray. The authors say it’s intrinsically impossible to understand non-existence because there would be no “I” to think about it. As they put it, “Trying to perceive your dead mind is paradoxical, because you have to perceive a state that is incapable of perception — which is impossible while you are currently perceiving.”

Mortals

Recently, while in the Sydney bookshop Dymocks hunting for something to read, I saw Mortals: How the Fear of Death Shaped Human Society. Written by two psychologists based in Sydney, Rachel Menzies and Ross Menzies, it seemed a perfect opportunity to refresh and update my understanding of death issues.

            Menzies and Menzies begin by tackling a big issue: religion. They go through several of the world’s major religions, including Christianity, Islam, Hinduism and Buddhism — the four largest in terms of adherents — arguing that much of their appeal comes from their promise of immortality, in one form or another. And why should anyone seek immortality? The fear of death, of course. If major religions are successful in recruiting and retaining followers due to their role in reducing the fear of death, this is indeed a powerful influence on human society. In some religions, your immortality comes via your mind, but in Christianity your body is part of the package, which presumably is more appealing. Menzies and Menzies say less about a negative side of immortality: the possibility of everlasting damnation. Why would religion be attractive if it comes along with the risk of going to hell? Maybe this uses the fear of death in an even more potent combination: frighten people with visions of hell and then promise everlasting life in heaven if only they believe.

            But is fear of death the key driver of religious belief? Research shows that people who are religious are happier, on average, than those who are not. Religious belief plays a role in this, but so do social relationships, which are known to promote happiness, among believers. Some religions have rituals involving expressing gratitude, something that reliably improves happiness. So there might be more to the attractions of religion than just warding off the fear of death.

TMT

In the 1980s, three researchers — Jeff Greenberg, Sheldon Solomon and Tom Pyszczynski — developed what is called Terror Management Theory or TMT. Despite the name, this has nothing to do with terrorism. It is about people’s fear of death, a fear so great as to warrant the word “terror,” and posits that this terror, even when not recognised consciously, has major influences on thought and behaviour. When I first read about TMT, years ago, it sounded a bit crazy, but there’s lots of research showing the impact of being reminded about death.

            In a typical experiment, the participants — most commonly undergraduate psychology students — are brought into the lab and asked to undertake a task, like solving anagrams. The task is seldom the real purpose of the study but is designed to distract their attention, so they don’t realise what the experimenter is trying to find out. Along the way, some participants are exposed to an article or video with images of death, whereas others, the controls, are exposed to a “neutral” equivalent like a cat video. Then there is a further task, or something happens, and the participants are watched to find out what they do. In one study, they needed to wash their hands, and the experimenters cleverly weighed soap dispensers and counted paper hand towels before and after.

            With ingenious experiments, researchers have discovered all sorts of fascinating things about how people react to being reminded of death. One finding is that some people become more willing to punish those not in their own group, such as foreigners. But only some people are affected this way, mainly those with certain personality traits or political orientations. Still, the overall picture is worrying. According to Menzies and Menzies, “Hundreds of studies show that nearly any reminder of death makes people more aggressive, more racist and more willing to inflict harsh punishments.” (pp. 82-83)

Living forever in the flesh

What are your prospects for immortality in your own body, here on Earth? Back in the 1970s, one of my colleagues, Tom, planned to have his body frozen when he died so that, with future recovery techniques, he could later be restored to life. This process is called cryonics. Tom wasn’t alone. Thousands of people have signed up to have their bodies, or just their heads, frozen at ultra-low temperatures in the hope of being brought back to life when the technology is available.

            Tom was a peculiar guy, lacking typical social skills. This was not uncommon for pure mathematicians, but Tom was at an extreme end. I used to imagine some future group of scientists restoring frozen people from a previous century and saying, “This is amazing. Everyone back in the 1970s was a lunatic!” If Tom was an emissary from our time to the future, he was hardly typical. But at least he was a gentle, introspective soul, not a megalomaniac.

            Menzies and Menzies use cryonics as one of many examples of the human quest for immortality. Incidentally, they give many reasons why the prospects for resuscitating a frozen brain are minimal: those relying on cryonics to have their minds restored have let hope triumph over the evidence.

Living forever symbolically

Menzies and Menzies offer a new perspective on Michelangelo’s painting of the Sistine Chapel. Michelangelo insisted on making this artwork a fresco, so it is part of the surface, making it far more lasting than a wall painting. In their telling, Michelangelo was willing to spend years of agonising effort so his art would be long remembered. In this, he was successful. However, most artists are not. Before long, they are forgotten.

            Menzies and Menzies argue that striving for symbolic immortality is important in driving cultural production. I thought this could apply to me because I’ve written lots of articles and books. The quest for a type of immortality may play a role, but there are other factors. Artistic production is one way to enter into a state called flow in which one’s focus is entirely on what’s happening and the sense of self recedes from consciousness. The pioneer researcher on flow, Mihaly Csikszentmihalyi, found that this is a highly desirable mental state that can be entered through all sorts of means, typically exercising a skill at a level challenging enough to avoid boredom but not so challenging as to induce anxiety. Quite independently of the fear of death, entering flow can be a motivator for producing artistic works. On the other hand, is flow a way to avoid thinking about death?

            Menzies and Menzies discuss several other ways that people try to deal with their unconscious fear of death, for example taking vitamin supplements and exercising. In every case, there are other factors. For example, physical activity is the most reliable way for people to feel better physically and mentally, which surely is a worthy goal even for those unconcerned about dying.

            The authors make a grand claim: “We have shown that nationalistic fervour, aggression against outgroups, religious wars, popping vitamins, endless hours on treadmills, investing in cryonics and futile health interventions all arise from failing to accept one’s mortality.” (p. 181) I think they’re on solid ground with cryonics, but for the other topics more is involved, and the precise role of the fear of death remains to be determined.

            Mortals is filled with fascinating information from cultures around the world. How about this? In Alabama, you can have your ashes incorporated into a shotgun shell. In this way, you can protect your family after you’re gone! Well, it’s only a replica, but it’s a thoughtful gesture.

            Menzies and Menzies are psychologists and have treated many patients with mental problems. They argue that the fear of death is an underlying factor in many mental illnesses that seem to be about something else. An example is a spider phobia. A therapist might try to reassure a patient by saying, “Don’t worry, you’re not going to die just by looking at a spider.” The trouble is that the patient is going to die, eventually, of something. To say that a fear of death underlies many mental disorders might sound outlandish, but Menzies and Menzies cite some striking evidence in support, including that the level of people’s death fears correlates with mental health problems, medication use, hospitalisations and the recurrence of problems.


Rachel Menzies

Implications

If the fear of death has so many harmful consequences, what is to be done? The authors say, basically, accept that you will die and get on with life. They tell about the Stoics, the philosophers in ancient Greece who advised not to worry about things you can’t control. This is good advice generally and certainly applies to the fact that everyone dies.

            Menzies and Menzies also discuss funeral practices, noting that the practice of embalming — routine in the US — is environmentally damaging. They discuss the “death-positive movement” that promotes acceptance of death and has led to environmentally friendly options for burial.

            On a much bigger scale is human overpopulation, a factor in the environmental crisis. Menzies and Menzies say having children is a way to help deal with the fear of death, because children carry on our genes and our culture. Also, in most societies, having children is looked on favourably and thus helps build self-esteem, a buffer against the fear of death. This is plausible, and then there’s research showing that when men are asked how many children they would like to have, they give a higher number after having been subliminally reminded of death.


Warding off a fear of death?

            The authors also argue that people’s belief that the human species is immune to disaster, including catastrophic global warming, derives from an inability to face death. You may not agree with all these assessments, but the stakes are potentially high. If you turn away from the evidence and arguments presented in Mortals, does that reflect an aversion to thinking about your own death?

            Reminders of death are all around us, in the news and entertainment, though this varies a lot depending on the culture. I started this post by mentioning death, and that should have influenced your thinking, at least in the short term. It’s definitely worth learning about how reminders about death affect us, so if you can stand an intense yet engaging tour of death-related topics, why not read Mortals?


Ross Menzies

Brian Martin
bmartin@uow.edu.au

Thanks to Chris Barker, Kelly Gates, Emily Herrington and Julia LeMonde for helpful comments.

Who’s afraid of The Real Anthony Fauci?

Robert F. Kennedy Jr.’s book The Real Anthony Fauci has sold over a million copies and was on best-seller lists for weeks. Yet, apparently, it has not been reviewed in the US mainstream media. This intrigued me.

            Since the beginning of the pandemic, I’ve been following arguments from a range of perspectives: the Covid orthodoxy — which keeps changing — and a diversity of critics. It was hard to avoid hearing about Kennedy’s book, published in November 2021, but I thought it probably addressed issues regularly canvassed among sceptics about Covid orthodoxy.

            I read about attacks on Kennedy and his book published in the New York Times and elsewhere, attacks that did not address the contents of the book (Brown, 2022). Still, that wasn’t enough to get me to read it. Then I read a commentary by Phillip Adams (2022), a prominent progressive voice who has a column in The Australian, otherwise a bastion of conservative opinion. Disappointingly, Adams disparaged Kennedy, calling him a “full-time conspiracy theorist,” and dismissed his book as “a long diatribe that would appeal to anti-vaxxers” without saying anything about the book’s contents. That did it: I resolved to read the book myself.


Robert F Kennedy Jr.

            The Real Anthony Fauci is about Fauci, to be sure, but in a wider sense it is about the pharmaceutical industry and its hold over the US and global health system. Fauci is the hook for a more wide-ranging examination.

            I am a social scientist, not a physician or medical researcher, and have not attempted to get to the bottom of claims and counter-claims about Covid and health matters more generally, for example studies of hydroxychloroquine or adverse reactions to vaccines. But based on a long study of the politics of health, it is possible to make some judgements about whether Kennedy’s analysis is compatible with scholarly treatments.

            The Real Anthony Fauci is a lengthy tome, massively referenced. Kennedy acknowledges a “team of researchers and fact checkers who sourced, cited, and fact-checked this manuscript” (p. xii), and indeed there are lots of “facts” in the book, more than a single investigator might expect to verify in a few years. The book is available in electronic form and in print which, due to the small font and narrow margins, is not appealing to the eye. Even so, I preferred to read the print version. There is no index.

            Another issue is the organisation of material. For the most part, the chapters are coherently written, but occasionally there are digressions, some of them reprising themes covered elsewhere. In other words, the book is not as tightly constructed as it might be. On the other hand, it is quite up to date, suggesting it might have been rushed to publication.

            In the following, I look in most detail at Kennedy’s treatment of Covid issues, and then turn to some other parts of The Real Anthony Fauci.

Pandemic matters

Many readers will be most interested in chapter 1, “Mismanaging a pandemic,” a lengthy and up-to-date treatment. Much of the chapter is on treatments for Covid, specifically hydroxychloroquine, ivermectin and remdesivir. Kennedy’s argument is that US health authorities and media followers tried to discredit cheap, safe and effective treatments, meanwhile promoting expensive, dangerous, less effective and inadequately studied responses.

            Here’s the story in brief, as presented by Kennedy. Hydroxychloroquine and ivermectin have been used for decades for a variety of health problems and have well-researched safety profiles. Some doctors and researchers thought they looked promising as treatments for Covid, tried them on patients and obtained positive results, often in protocols also involving zinc, vitamin C, vitamin D, quercetin and other supplements and medications.

            The US medical establishment, in which Fauci played a key role, did not initiate a massive research effort to see whether these protocols were effective. Instead, they poured money into a patented treatment drug, remdesivir, and into the development of vaccines. Then, when some doctors and researchers championed hydroxychloroquine and ivermectin, Fauci et al. mounted an attack on these two drugs and tried to deregister or discredit their supporters. You might have heard ivermectin referred to as a “horse dewormer,” making it seem ill-advised for human use. Media coverage with this sort of depiction seldom mentions that doctors regularly prescribe drugs “off-label.” Calling ivermectin a horse dewormer reminded me of antifluoridationists who call fluoride “rat poison.” Sodium fluoride is indeed used as rat poison but only in doses far greater than can be obtained from the fluoride added to public water supplies to reduce tooth decay. Similarly, that ivermectin is used as a horse dewormer should not automatically discredit its use, in much smaller doses, as a preventive or early treatment drug for Covid.

            Kennedy documents a massive campaign to discredit hydroxychloroquine and ivermectin. This campaign had a research dimension. Some studies of hydroxychloroquine used it only on seriously ill patients when, according to proponents, it is least effective. Kennedy says researchers set up their studies to show hydroxychloroquine didn’t work.

            Then there was a major paper published in the prestigious medical journal The Lancet based on nearly one hundred thousand patients in numerous hospitals, definitively showing hydroxychloroquine was ineffective. It seemed like the coup de grace until it was revealed that the data could not be verified. The company running the study apparently organised a giant fraud. The Lancet retracted the paper.

            Why should there be such a campaign against cheap drugs that showed promise in treating Covid? Kennedy gives an answer: the US Food & Drug Administration, by law, cannot approve a vaccine for emergency use if there is an available treatment. Pharmaceutical companies, then spending vast amounts of money developing Covid vaccines, would not have their vaccines approved quickly if hydroxychloroquine, ivermectin or other therapies were shown to be effective as treatments.

            Kennedy quotes supporters of these two drugs saying that if they had been widely available in the US, hundreds of thousands of lives could have been saved. Instead, according to Kennedy, the CDC (Centers for Disease Control and Prevention), in an unprecedented move, ordered doctors to stop prescribing ivermectin, bought up stocks so they would not be available for sale, and encouraged pharmacists to refuse to fill doctors’ prescriptions.

            Meanwhile, Fauci’s favoured treatment drug, remdesivir, was pushed through the approval process despite studies showing minimal benefits and a high-risk profile. According to critics quoted by Kennedy, the use of remdesivir contributed to the death toll from Covid in the US.

            Then came the vaccines. Kennedy provides figures showing Covid vaccines are far less than fully effective and cause far more adverse reactions than officially reported.

            The underlying motive, or factor, is clear enough: pharmaceutical company interests. Hydroxychloroquine and ivermectin are not under patent, and a course of either one costs only a few dollars, so there is little money to be made from them. In contrast, remdesivir and Covid vaccines were financial bonanzas, offering profits of billions of dollars.

            This story is a damning indictment of the US medical establishment, basically saying that cheap and effective treatments were discredited and made hard to obtain so that proprietary drugs and vaccines, with dubious safety profiles, could become the preferred way to deal with Covid, all at the expense of large numbers of lives. This story is almost a reversal of the views presented by government officials and the mass media, in which hydroxychloroquine and ivermectin are suspect and vaccines the only long-term solution.

            Is Kennedy’s analysis of pandemic politics compatible with viewpoints expressed in the field of social analysis of health and illness? To address this question, I look in turn at four areas: undone science, analyses of big pharma, the role of Fauci, and suppression of dissent.

Undone science

David Hess, professor of sociology at Vanderbilt University and author of many works on science and health, developed the concept of “undone science” (Hess, 2016). It refers to research that could be undertaken, and is called for by civil-society groups, but is not pursued because the findings might be unwelcome to powerful groups. Undone science is most commonly found in the areas of environment and health. Hess focuses on undone science involving environmental risk, but the concept can also be applied to vaccination safety research.

For many years, critics have called for comprehensive studies comparing the health of unvaccinated and fully vaccinated children (e.g., Golden, 2019), but governments have not funded any such studies. It could be that such studies would definitively show the benefits of childhood vaccines but there is a risk they might show harms greater than publicly acknowledged. So this research remains undone except for relatively small studies not funded by governments or vaccine manufacturers.

            The concept of undone science sidesteps debates about the nature of knowledge, focusing instead on research agendas. It can be slightly broadened by referring to topics that companies or governments investigate but then do not publish their findings.

            Kennedy’s account of hydroxychloroquine and ivermectin fits perfectly in the model of undone science. Despite calls from doctors and patient groups for studies of these and other cheap and widely used drugs for Covid, pharmaceutical companies and governments did not urgently pour billions of dollars into studies. They basically ignored these calls, instead channelling their research dollars towards proprietary options. This does not prove that hydroxychloroquine and ivermectin are effective, but it does suggest that the way the medical establishment responded to calls for studying these drugs fits a well-established pattern.

Big pharma

It may seem shocking to imagine that companies making billions of dollars would compromise the health of populations just so they could make more billions. Is this plausible?

            In the 1960s, the German drug company Grünenthal marketed a morning sickness drug, promising wonderful effects. The company began receiving reports from doctors that their patients were suffering serious side effects from the drug, including peripheral neuropathy. Grünenthal ignored the reports and continued marketing the drug, and in some cases tried to discredit the doctors. This might have continued indefinitely, but then reports were published about pregnant women on the drug giving birth to children with serious deformities. This was enough to have the drug withdrawn from sale. Despite the damning evidence, Grünenthal denied responsibility and fought lengthy legal battles to avoid paying compensation (Insight Team, 1979).

            This is the story of the drug thalidomide, which became a famous emblem of corporate culpability. Was Grünenthal’s behaviour an outlier or a sign of things to come?

            Consider the tactics used by Grünenthal: marketing a drug before it had been sufficiently tested, ignoring reports of adverse effects, attacking critics and undertaking protracted legal means to avoid paying compensation — and never admitting wrongdoing. For some, it may be hard to believe companies could act in such a way. After all, they present themselves as supplying valuable solutions to health problems. Could they really be corrupt, enriching the pockets of executives and shareholders at the expense of public health?

            According to a range of critics, the answer is yes. The story of thalidomide became notorious but the same pattern has been repeated many times, except with less adverse publicity: the companies have become more sophisticated in their efforts to make exceptional profits without accountability.

            Ben Goldacre is a doctor and science journalist who wrote a scathing attack on alternative medicine, Bad Medicine (Goldacre, 2008). Then a few years later, he wrote Bad Pharma, an exposé of the pharmaceutical industry, giving example after example of how researchers studying drugs for companies fudge their results, for example by fixing endpoints, ignoring adverse effects and using physiologically active placebos. Bad Pharma provides revealing stories of what might be called systematic scientific fraud (Goldacre, 2012).

            Sergio Sismondo is a prominent figure in the field of science and technology studies, among other things having been editor of the premier journal Social Studies of Science for many years. He undertook a detailed investigation of the publication and marketing practices of pharmaceutical companies, for example attending conferences for pharmaceutical company liaisons and sales representatives, who use various forms of persuasion to encourage doctors to prescribe favoured drugs. In his book Ghost-managed Medicine, Sismondo (2018) documents the process by which company researchers produce papers for publication in top medical journals, finding academics who have had little or no involvement in the research to be the nominal authors, thereby giving the papers greater credibility. After publication, these papers are distributed to as many as hundreds of thousands of doctors as part of well-coordinated marketing efforts. In Sismondo’s picture, medical research is a just part of a marketing enterprise.

            Peter Gøtzsche is a medical researcher who helped set up the Cochrane Collaboration, a network of independent scientists who carry out assessments of drugs and other medical interventions. Gøtzsche himself is a highly energetic investigator and a fierce critic of shoddy research and corrupt practice. In his book Deadly Medicines and Organised Crime, Gøtzsche (2013) gives numerous examples of pharmaceutical companies that market products they know are dangerous. He says the pharmaceutical industry is just like organised crime in knowingly harming people, the main difference being that the industry kills far more people than organised criminals.

            In addition to analyses by Goldacre, Sismondo and Gøtzsche, one can turn to indictments by former editors of major medical journals (Angell, 2005; Smith 2005). Then there are pharmaceutical company whistleblowers who have told about corrupt practices from an inside perspective, as well as about the reprisals they suffered for speaking out (Rost, 2006).

            In this context, Kennedy’s analysis of Covid politics is nothing surprising. It is plausible that companies would promote responses to the pandemic that serve their own interests, even at the potential cost of large numbers of lives.

            But how could scientists and executives do such a thing? For the scientists, it is straightforward: they are part of a larger system, and they can just focus on their own narrow tasks (Schmidt, 2000). For executives and others, belief systems are convenient. They can truly believe that they are serving the public interest — or they can adopt any of various justifications for their actions. It’s not necessary to imagine that those who promote medical interventions as the solution to the pandemic have some secret agenda, scheming to cull the population. There is a well-known precedent, after all: the tobacco industry, responsible for the premature death of tens of millions of people (Proctor, 2012). We don’t need to think big tobacco is run by homicidal maniacs with a secret agenda. Well, they do have secrets, but for the purpose of maintaining and expanding markets for their products and making more money.

The role of Fauci

Kennedy’s book is titled The Real Anthony Fauci so it is hardly surprising that Fauci plays the lead role in Kennedy’s account of responses to Covid. Kennedy says relatively little about the politics of treatments and vaccines outside the US, except in as much as they support his argument. Is it reasonable to blame Fauci personally for so much of Covid policy?


Anthony Fauci

            One alternative is to use a structural analysis, standard in social science, that focuses on institutions and processes and sees individuals as epiphenomena. In this sort of picture, the drivers of the responses to the pandemic include the pharmaceutical industry which created the basis for a Covid paradigm — a hegemonic way of understanding Covid and what to do about it — that serves to support the industry’s interests. Responses to the pandemic were also influenced by political leaders who gained support by implementing tough policies, from the mass and social media that gave saturation coverage of the Covid threat without much historical or social context, and audiences frightened by a Covid hysteria and who looked to authorities for protection.

            Using this sort of structural analysis puts Fauci in a different light. He may have had an outsized influence on developments, but if someone else had been in his position, the outcome may not have been all that different. How to assess the value of a Fauci-centred analysis as compared with a structure-centred analysis is not straightforward. One way to proceed might be to undertake a comparative analysis of Covid responses in different parts of the world, looking at the roles of key individuals and policy decisions. For example, is the Swedish policy, widely seen as a contrast with policies in other European countries, better explained by Swedish history and institutions or by the influence of key individuals, or some combination?

            Kennedy’s focus on Fauci can also be understood as a narrative device, as a way of creating interest in the story. Readers may be more attracted by a story of a scheming individual than by the operations of faceless organisations and sets of ideas. You are reading Kennedy’s story about Fauci, the master manipulator at the centre of a web of influence, and learning about drugs, policies and much else along the way, without having to plough through the sort of prose found in a sociology monograph.

Suppression of dissent

In a revealing passage (pp. 142–143), Kennedy tells how for years he was able to have articles published in major newspapers and was widely sought after as a speaker on environmental issues. Then in 2005 he wrote an article about corruption in CDC’s vaccine branch, published in both Salon and Rolling Stone — and everything changed. His articles were removed, newspapers henceforth refused to publish his articles, and speaking engagements dried up due to complaints to venues or hosts.

            Throughout The Real Anthony Fauci, Kennedy describes how critics of orthodoxy have been suppressed, including losing their funding, being deregistered and being subject to derogatory misrepresentations. For example, in the 1970s, distinguished scientist J. Anthony Morris questioned the promotion of a flu vaccine. Kennedy describes the methods used against Morris: “… enforced isolation, disgrace, prohibiting him from publishing papers, presenting at conferences, or talking to the press, changing his laboratory locks to prevent further research …” (p. 360). I had read about this case earlier (Boffey, 1976).

            Based on my studies of “suppression of dissent” (Martin, 1999, 2015), this aspect of Kennedy’s account is completely believable. What he describes accords with experiences reported by hundreds of other scientists and campaigners.

Pandemic matters: summary

Kennedy provides a hard-hitting critique of US pandemic policy. Contrary to the official narrative that vaccines are the salvation and that hydroxychloroquine and ivermectin are kooky or dangerous, Kennedy argues that these two generic drugs, if used appropriately, are potent treatments for Covid. If they had been recognised and widely used, they might have reduced the US Covid death toll by hundreds of thousands. Accepting them as valid treatments, though, would have meant that Covid vaccines should not have received emergency use authorisations, and the proprietary drug remdesivir would not have been favoured. Behind this scandal, Kennedy says, is Anthony Fauci, the Covid-response kingpin whose actions faithfully served the pharmaceutical industry at the expense of public health. If Kennedy’s account is accepted, it points to one of the greatest scandals in the history of US public health.

            As a way of reflecting on Kennedy’s claims, I asked myself whether his analysis is compatible with analyses in the sociology of health and illness. Overall, it is. It is well documented that the pharmaceutical industry often has pursued profits over patient health, has silenced, discredited and suppressed those who challenge its agendas, and has colonised the medical profession to serve its own ends. Sociologists would probably not place so much importance on a single person, Fauci in this case, as being responsible for abuses, but instead would point to institutional and systemic processes, but this does not change the basic compatibility of Kennedy’s account with scholarly perspectives. This does not mean Kennedy’s account is right, just that it should not be ruled out as implausible. If it is considered a conspiracy theory, it might well be about a real conspiracy. I now turn to some other parts of The Real Anthony Fauci.

AIDS

Kennedy, after looking at Covid, turns to earlier stages in Fauci’s career, especially concerning AIDS. From the 1980s, Fauci was involved in the US response to AIDS, which was first diagnosed in 1981. For treating AIDS, Fauci championed the drug AZT, which turned out to be highly toxic.

            Kennedy, to show Fauci’s intolerance of contrary views, gives extensive commentary on the view that HIV is not responsible for AIDS, or not fully responsible. Starting in the late 1980s, this HIV-AIDS heresy was championed by Peter Duesberg, a highly prominent virologist. Previously he had received generous, prestigious funding for his research; after questioning HIV-AIDS, he was vilified and all his grant applications failed. He had difficulty publishing scientific papers, even in venues where normally he had guaranteed access.

            I have long been aware of HIV-AIDS dissent and the treatment of Duesberg, even citing it as an example of heresy in medicine. However, I never delved into the issue deeply, in large part due to my involvement in another AIDS debate, specifically the theory that AIDS developed from contaminated polio vaccines used in central Africa in the late 1950s. In 1991, I arranged for the publication of a working paper about this view (Pascal, 1991), which led to close contact with several of the key figures in the debate over the origin of AIDS, including the indefatigable investigator Edward Hooper (2000).

            Not long after the discovery of HIV, the human immunodeficiency virus, in 1983, a related virus was discovered in monkeys, simian immunodeficiency virus, SIV. Immediately, scientists speculated that SIV — of which there are many variants — had somehow gotten into humans and become transmissible. The question was how. One suggestion was that it was from people eating monkey meat. Another was that a hunter, in butchering a monkey, got monkey blood in a cut. This view can be called the cut-hunter theory or the bushmeat theory.

            Then there was the polio-vaccine theory. Polio research pioneer Hilary Koprowski ran trials involving polio vaccines that were administered orally to up to a million people in central Africa. These vaccines were cultured on monkey kidneys, offering a pathway for contamination by SIVs. Many scientists intensely disliked this theory. Naturally, the polio pioneers accused of accidentally causing AIDS were strong opponents, and a number of others joined them. I had a front-row seat in seeing the underhanded techniques used to censor and discredit the polio-vaccine theory, including blocking publications, suing for defamation, manipulating a scientific conference and making false claims (Martin, 2010).


Hilary Koprowski

            With this experience, it is easy to say that Kennedy’s treatment of Duesberg and HIV-AIDS dissent fits a pattern of suppressing dissent from AIDS orthodoxy. The question that came to my mind was, why did Kennedy give so much attention to the HIV-AIDS dissent and not even mention the origin-of-AIDS controversy? An obvious factor is that Fauci was centrally involved in the response to Duesberg and his allies but played no role in the response to the polio-vaccine theory.

            Kennedy states that “From the outset, I want to make clear that I take no position on the relationship between HIV and AIDS.” (p. 178). Nevertheless, in writing about HIV-AIDS, he gives extensive explanations of the viewpoint of Duesberg and other dissidents, focusing almost entirely on AIDS in the US. In this perspective, early US AIDS cases were attributable to poppers and other drugs used widely in the gay community, and later cases were due to AZT, the drug widely used to treat AIDS, with toxic consequences. This is a cogent account of the case that HIV is not responsible for AIDS. But it is one-sided. Nowhere does Kennedy mention evidence that might be difficult for Duesberg to explain. Why, for example, are the earliest cases of HIV-positive blood traced to central Africa from 1959 and after? Why did Ugandans recognise Slim, the local name for AIDS, as a new disease at the start of the 1980s, just as HIV appeared there? (Hooper, 2000, pp. 168–169). If HIV is simply a passenger virus, as Duesberg argues, why did it seem to emerge about the same time as the earliest cases of AIDS, and in the same location? I’m aware that Duesberg and his supporters can come up with explanations for anomalies like this. My point is that Kennedy has given only the information that HIV-AIDS dissidents can more easily explain.

A fatal flaw?

One-sidedness is a feature throughout The Real Anthony Fauci. Earlier I described Kennedy’s writing about Covid, specifically about hydroxychloroquine, ivermectin, remdesivir and vaccines. In relation to hydroxychloroquine and ivermectin, Kennedy writes like a lawyer for the defence; in relation to remdesivir and vaccines, he writes like a prosecutor.

            Is this a fatal flaw in his arguments? If it is, the same fatal flaw is present in most of the writing giving the standard, official views about Covid, which offer no acknowledgement of any contrary evidence. For example, official pronouncements about hydroxychloroquine never cite the many studies showing its effectiveness against Covid. In this context, Kennedy is presenting views to counter a one-sided orthodoxy. Furthermore, he is confronting an establishment committed to censorship and suppression. He has taken his opportunity to present a challenging view in as strong terms as he can manage. Nearly all of his readers will be fully aware of the orthodox view, which is dominant in mainstream sources and which shapes policy. So, in a sense, Kennedy might be excused for being one-sided.

            It’s useful to remember that The Real Anthony Fauci has been a bestseller that has received no reviews in mainstream media, only attacks. If Kennedy’s arguments are so dangerous, why not respond to them in a careful manner rather than trying to censor the message and discredit the messenger? One consequence of official intolerance of dissent is that some of those with reservations about the official line will find a well-documented presentation of contrary views persuasive. They might feel their only choices are orthodoxy or a Kennedy-informed heterodoxy.

Gates

The subtitle of Kennedy’s book is Bill Gates, Big Pharma, and the Global War on Democracy and Public Health. Bill Gates, the co-founder of Microsoft, is well known as one of the world’s richest people. He and his former wife set up the Bill and Melinda Gates Foundation which has dispensed billions of dollars for the cause of public health. At the same time, many commentators in the Covid-critical community see Gates as an evil manipulator, one who might even have depopulation as part of a sinister agenda.


Bill Gates

            Kennedy quotes critics of Gates’ so-called “philanthrocapitalism” who point out that the Gates Foundation, while giving away large amounts of money, is becoming even wealthier, as indeed has Gates himself. The explanation is Gates’ investments in pharmaceutical companies and the Gates Foundation’s focus on vaccination as the solution to the world’s health problems, especially those in Africa.

            According to Kennedy, the Gates Foundation, by making generous donations, has colonised international bodies like the World Health Organization, major research bodies and the mass media. In Africa, Gates promotes vaccines while long-time development experts say primary health care is more important. The money poured into vaccines has meant neglect of the basics, including adequate food and clean water. In other words, Kennedy says, Gates’ prioritising of vaccines is serving the interests of pharmaceutical companies rather than those of people in need. Throughout his book, Kennedy makes the point that Fauci, Gates and those in their thrall put disproportionate emphasis on vaccines and drugs while neglecting efforts to build people’s immune systems through better nutrition and hygiene. In summary: “… global public health advocates accuse Bill Gates and Dr. Fauci of hijacking WHO’s public health agenda away from the projects that are proven to curb infectious diseases (clean water, hygiene, nutrition, and economic development) and diverting international aid to wedge open emerging markets for their multinational partners and to serve their personal vaccine fetish.” (p. 323)

            Does this sound conspiratorial? It might, but there is no need to invoke conscious scheming. As studies of paradigms suggest, it is quite possible for Gates to be serving his own interests while sincerely believing that he is playing a life-saving role for hundreds of millions of people.

Intellectual property

A revealing indication of priorities is the role of intellectual property (IP) in public health. The rationale for IP, which includes copyright and patents, is to stimulate the production of new ideas and products by giving a temporary monopoly to the creator. I am one of many critics of IP, on several grounds (Martin, 1995). At the simplest level, the length of copyright terms, now standing at 70 years after an author’s death, is vastly longer than needed to stimulate more creative works. More generally, IP primarily benefits big companies in software, publishing, genetically modified foods, Hollywood entertainment — and pharmaceuticals.

            Intellectual property is a restraint on innovation justified by the need to stimulate more innovation, but big companies regularly use their controls to stymie competitors. This process is institutionalised in global agreements, most famously TRIPS (Trade-Related Aspects of Intellectual Property Rights). The US government has been the most aggressive in pushing to include stronger IP controls in trade agreements, even though for practical purposes IP restrains trade.

            Sometimes IP comes in direct conflict with public health. After AIDS drugs were developed, pharmaceutical companies charged exorbitant prices for them. Governments in low-income countries argued that these drugs should be compulsorily licensed so they could be made available at close to production costs and thereby be used to treat millions of AIDS patients who otherwise would not be able to afford them. The companies, backed by Gates and his entities, vigorously opposed this relaxation of tight IP controls. Gates, in software and drugs, put IP-derived profits above public health.

            Then came Covid and the same scenario, this time with vaccines and public health. The pandemic was proclaimed to be a public health emergency that warranted the most urgent efforts to develop vaccines that would be rolled out for the world’s entire population. But when governments asked for compulsory licensing so manufacturers of generics could provide otherwise unaffordable vaccines, the companies and Gates resisted.

            The willingness of big pharma and its government allies to fight against making their products available at low cost to fight pandemics — AIDS and Covid — is a damning indictment, yet it has received little media attention. Kennedy recounts how the Gates Foundation has made significant donations to media organisations, most of which muzzled themselves when it comes to any questioning of orthodoxy even when, as with licensing of drugs and vaccines, the realities of IP protection clash with public health priorities.

Depopulation?

Perhaps the most outlandish-seeming claims about Fauci and Gates are that they have a depopulation agenda. Kennedy addresses several versions, inadvertent and intentional.

            Inadvertently, some vaccine promotion efforts may lead to higher death rates. Scientist Peter Aaby and colleagues have studied the mortality of children in Guinea-Bissau following various vaccines (Aaby et al., 2018; Kristensen, 2000). The measles vaccine reduces mortality significantly but the DTP triple vaccine (diphtheria, tetanus and pertussis) increases mortality, quite dramatically for young girls. Years ago, the whole-cell pertussis component of DTP was found to be dangerous, so in the West it was replaced by an acellular version, with the resulting triple vaccine denoted as DTaP. However, as Kennedy reports, WHO, supported by Gates, continued to promote the more dangerous DTP version in Africa. This might be called an inadvertent depopulation process.

            Then there is the way vaccine promotion in low-income countries actually hurts population health by diverting money from basic measures such as providing clean water. Kennedy gives the example of the hepatitis B vaccine, promoted in India despite the disease it targets, hepatocellular carcinoma, not being a significant health problem in the country. Furthermore, according to Kennedy, Gates’ entities and allies pushed the WHO to include the hepatitis B vaccine in the mandated list of vaccines worldwide, irrespective of whether it addressed a significant problem. This meant governments paid large amounts to pharmaceutical companies for the vaccines; Gates has large holdings in these companies, so by giving money away he increases his fortune. By diverting scarce funds from more important health problems, this vaccine-promotion agenda could be said to be an inadvertent depopulation process.

            Then there are overt measures to control populations: promotion of anti-fertility drugs. Kennedy presents evidence suggesting that some vaccination programmes in low-income countries were covers for administering anti-fertility drugs, notably one called Depo-Provera. He cites writers who note that the schedule for giving the vaccines was one injection every six months for several years, rather than the usual pattern for the tetanus vaccine. Kennedy also refers to Gates’ longstanding interest in population control.

            The administration of anti-fertility drugs under the guise of vaccination, without proper consent, is obviously scandalous. However, even if true, it is not necessarily evidence of an intent to kill vast numbers of people, as might be suggested by the term “depopulation.” If Kennedy’s claims are correct, they are compatible with Gates sincerely seeking to address the problem of overpopulation, albeit sometimes with unethical means.

Conclusion

The Real Anthony Fauci is an impressive book, covering a wide range of important topics with extensive referencing. There is much more in the book that I have not discussed, including chapters on declaring pandemics and on biological warfare. I have not tried to pass judgement on Kennedy’s claims but rather to comment on whether his general perspective is compatible with some of the analyses by scientists and social scientists who have studied the same issues. For the most part, it is.

            The Real Anthony Fauci is, in parts, far more strident than typical scholarly treatments. In places, it reads like a diatribe, especially against Fauci and Gates. For example, Kennedy writes, “Blind faith in Saint Anthony Fauci may go down in history as the fatal flaw of contemporary liberalism and the destructive force that subverted American democracy, our constitutional government, and global leadership.” (p. 231). Many scholars would look less at the role of individuals and more at social structures, in particular at social systems that allow certain individuals to have an inordinate role in decision-making.

            A serious criticism of The Real Anthony Fauci is that it is one-sided. It presents lots of damning information but seldom attempts to present the other side, except to attack it. Discerning readers need to be aware that this is a critique of Covid orthodoxy and of the actions of the pharmaceutical industry and its most powerful supporters in government, science and philanthropy.

            The one-sidedness of the book might be considered, in context, a counter to the one-sidedness of the orthodox position concerning the pharmaceutical industry, Covid and vaccination. There is a certain symmetry here: both defenders and critics of orthodoxy give insufficient recognition to the other side. But there is a big difference. The defenders of Covid and pharmaceutical orthodoxy are backed by vast wealth and power, including the power to censor critics. The New York Times published attacks on Kennedy, meanwhile refusing to run an advertisement for his book (Lyons, 2022).

            There is one other difference between The Real Anthony Fauci and the many scholarly critiques that raise similar concerns: Kennedy’s book has sold over a million copies. In the age of Covid, it testifies to a widespread interest in seeing a well-documented perspective that questions the official line. That mainstream media decline to review the book or to address its claims shows the importance of a critique that reaches a wide audience.

Acknowledgements

For valuable comments on drafts, I thank Kevin Dew, Bob Dildine, Kurtis Hagen, Ed Hooper, Olga Kuchinskaya, Susan Maret and Sergio Sismondo. None of them necessarily agrees with Kennedy’s views or my own.

References

Aaby, Peter, Søren Wengel Mogensen, Amabella Rodrigues and Christine S. Benn. 2018. “Evidence of increase in mortality after the introduction of diphtheria-tetanus-pertussis vaccine to children aged 6–35 months in Guinea-Bissau: a time for reflection?” Frontiers in Public Health 6(79), 1–10.

Adams, Phillip. 2022. “Conspiracy of fools,” Weekend Australian Magazine, 19 February, 42.

Angell, Marcia. 2005. The Truth about the Drug Companies: How They Deceive Us and What to Do about It. New York: Random House.

Boffey, Philip M. 1976. “Vaccine imbroglio: the rise and fall of a scientist-critic.” Science 194 (December 3), 1021–1024.

Brown, Steve. 2022. “RFK, Jr.’s ‘The Real Anthony Fauci’ is a record-smashing bestseller — but mainstream media pretends it doesn’t exist.” Children’s Health Defense, February 17. https://childrenshealthdefense.org/defender/rfk-jr-the-real-anthony-fauci-record-smashing-bestseller/

Goldacre, Ben. 2008. Bad Science. London: Fourth Estate.

Goldacre, Ben. 2012. Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients. London: Fourth Estate.

Golden, I. 2019. “Reluctance to vaccinate: reasons and solutions.” Journal of Translational Science 5, 1–6.

Gøtzsche, Peter C. 2013. Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. London: Radcliffe.

Hess, David J. 2016. Undone Science: Social Movements, Mobilized Publics, and Industrial Transitions. Cambridge, MA: MIT Press.

Hooper, Edward. 2000. The River: A Journey to the Source of HIV and AIDS. Boston: Little, Brown. http://www.aidsorigins.com/the-river-a-journey-to-the-source-of-hiv-and-aids-2021-edition-by-edward-hooper/#more-3529

Insight Team of The Sunday Times (Phillip Knightley, Harold Evans, Elaine Potter and Marjorie Wallace). 1979. Suffer the Children: The Story of Thalidomide. London: André Deutsch.

Kennedy, Robert F., Jr. 2021. The Real Anthony Fauci: Bill Gates, Big Pharma, and the Global War on Democracy and Public Health. New York: Skyhorse.

Kristensen, Ines, Peter Aaby and Henrik Jensen. 2000. “Routine vaccinations and child survival: follow up study in Guinea-Bissau, West Africa.” BMJ 321 (December 9), 1–8.

Lyons, Tony. 2022. “We tried to run an ad for ‘The Real Anthony Fauci’ in The New York Times. Here’s what happened.” Children’s Health Defense, March 13. https://childrenshealthdefense.org/defender/ad-the-real-anthony-fauci-the-new-york-times

Martin, Brian. 1995. “Against intellectual property.” Philosophy and Social Action 21(3), 7–22. https://www.bmartin.cc/pubs/95psa.html

Martin, Brian. 1999. “Suppression of dissent in science.” Research in Social Problems and Public Policy 7, 105–135. https://www.bmartin.cc/pubs/99rsppp.html

Martin, Brian. 2010. “How to attack a scientific theory and get away with it (usually): the attempt to destroy an origin-of-AIDS hypothesis.” Science as Culture 19(2): 215–239. https://www.bmartin.cc/pubs/10sac.html

Martin, Brian. 2015. “On the suppression of vaccination dissent.” Science and Engineering Ethics 21(1), 143–157. https://www.bmartin.cc/pubs/15see.html

Pascal, Louis. 1991. What Happens When Science Goes Bad. The Corruption of Science and the Origin of AIDS: A Study in Spontaneous Generation. Working Paper No. 9, Science and Technology Studies, University of Wollongong, Australia. https://www.bmartin.cc/dissent/documents/AIDS/Pascal91.html

Proctor, Robert N. 2012. Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. Berkeley, CA: University of California Press.

Rost, Peter. 2006. The Whistleblower: Confessions of a Healthcare Hitman. Brooklyn, NY: Soft Skull Press.

Schmidt, Jeff. 2000. Disciplined Minds: A Critical Look at Salaried Professionals and the Soul-Battering System that Shapes their Lives. Lanham, MD: Rowman & Littlefield.

Sismondo, Sergio. 2018. Ghost-managed Medicine: Big Pharma’s Invisible Hands. Manchester: Mattering Press. https://www.matteringpress.org/books/ghost-managed-medicine

Smith, Richard. 2005. “Medical journals are an extension of the marketing arm of pharmaceutical companies.” PLoS Medicine 2(5), e138. https://doi.org/10.1371/journal.pmed.0020138

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Brian Martin
bmartin@uow.edu.au

Can you focus as well as you’d like?

What do gym-goers think about when they’re lifting weights? I don’t know, but in recent years I can see what half of the gym-goers are looking at between sets: their phones. Some become so engrossed that they seem to forget, for a while, that they’re at the gym.

            Outside, walking along, when I come up behind a young person who is walking slowly, I guess they’re multitasking: walking and checking their phone. Usually they are.

            For years I’ve been fascinated with attention, including what we pay attention to and how we maintain it. Part of the challenge is having some control over our attention when others are trying to hijack it, for their own purposes. You might be trying to read but the children want you to do something with them. Or you get a call from a friend. Sometimes interruptions are welcome, such as when you’re doing a boring task and you need a break.

            Interruptions from children and friends are one thing. Interruptions for commercial purposes are another. For quite a few years I’ve been reading about how advertisers seek to capture people’s attention.

            For an eye-opening survey of media and attention, see Tim Wu’s book The Attention Merchants: The Epic Scramble to Get Inside Our Heads. Wu tells how US and UK military propaganda methods were adopted by advertisers, who then pioneered more effective methods. According to Wu, the standard method for capturing your attention is to offer something for free — or just seeming to be free — and then resell your attention to advertisers. Because attention is scarce and there is competition, the race heads downwards, seeking to engage with the intuitive mind and sidestep the rational mind. From The Attention Merchants I learned a different way of understanding developments in television, celebrities, blogging, Facebook and much else. My blog post.

            For understanding how social media have become so good at capturing attention, turn to Adam Alter’s book Irresistible: Why We Can’t Stop Checking, Scrolling, Clicking and Watching. It’s a highly engaging account of behavioural addictions, covering evidence for their rise (especially via smart phones), addictive tendencies, the biology of addiction, the engineering of behavioural addiction through goals, feedback, escalation, cliff-hangers and social interaction, and what to do about it. Alter provides a stimulating treatment of gamification, in which activities are turned into games. He addresses how habits are formed. My blog post.

Stolen focus

Then I heard about Johann Hari’s new book addressing attention. I had learned a lot from his first two books, Chasing the Scream about the war on drugs and Lost Connections about depression. Hari writes in a highly engaging way, telling about his search for answers to crucial questions, drawing on his own experiences and interviews with key participants and researchers.

            Hari’s new book is titled Stolen Focus: Why You Can’t Pay Attention. He starts with the observation that many people don’t seem to be able to focus for as long as they used to. He tracks down researchers who have studied the capacity to focus. They say the evidence does show that, on average, people’s capacity to focus is declining. Hari wants to find out why.

            He first tackles the most obvious explanation: social media and apps. You might think you are in control of what you do when using your phone. Think again.

            Hari interviewed a former Google engineer, Tristan, who says that success for Google workers was getting more people engaged, in other words hooked. This was not a nefarious plot but simply maximising income: engagement brings in more money from advertisers. At Google and elsewhere in Silicon Valley, no one thought about what they were doing to people’s attention.

            When you use your smartphone, the phone is smarter. The apps are designed by some of the smartest people on the job market to capture your attention. Hari lists several ways that websites and apps are designed that harm attention.

  1. They train your mind to crave rewards – frequent ones.
  2. They encourage you to switch tasks. Task-switching disrupts attention.
  3. They learn what make you tick and use what they learn to distract you and keep you on the platform.
  4. They make you angry, because being angry keeps you engaged. The result is that online, condemning rather than understanding has become the norm.
  5. They make you feel like you’re surrounded by angry people, though this is partly a result of getting everyone engaged.

The result is that your capacities — your intelligence, rationality and focus — and those of others are downgraded.

            What should be done? Why not just take control? Switch off notifications. Unsubscribe from lists. Set your phone to be offline for designated periods. When you go to bed, put it in another room. Hari talked with Nir, who helped develop engrossing apps and then wrote a book about how to resist them. Hari agrees that individuals can do a lot to protect themselves from perpetual distraction, but it’s not enough. When users are up against highly sophisticated algorithms designed to bypass rational controls, only a few have the resources to resist effectively.

            Hari supports individual efforts but thinks collective action is needed to bring websites and app design into a different model, one that supports users rather than exploits them. He gives a nice example of what could be done. It would be simple to develop an app to tell you about everyone in your neighbourhood who would like to go out for dinner, right now. But such an app isn’t available because it would help people go offline.


Johann Hari

What else?

A good portion of Stolen Focus is about devices that hijack your attention, but Hari thinks there are other factors, and continues his explorations. Another important contributor is insecurity. If you’re worried about your job or being able to pay your bills, then it’s harder to concentrate. With the rise of the gig economy in which many people can only obtain insecure and irregular employment, it is no surprise that anxiety levels escalate and attention suffers. Hari argues that a UBI, a universal basic income that is provided to everyone with no strings attached, would do a lot for people’s attention, and for their happiness as well.

            Another factor is your diet. Do you ever binge on junk food? When you aren’t getting enough nutrients, that’s a problem. When you get too much sugar, then after a while your blood sugar level crashes, and your capacity to focus suffers. Add to this environmental chemicals that can affect the brain, especially kids’ brains. Hari says added chemicals in food, as well as ones in the environment, are damaging to attention.

            Finally, Hari explores the way that children, in many affluent societies, are continually monitored. Due to exaggerated fears of child abductions and the promotion of “stranger danger,” many parents no longer allow their children to walk or cycle to school or to play unsupervised. Actually, says Hari, children need the opportunity to organise their own activities. Adults, by their excessive oversight, are not meeting their children’s needs.

Here’s how he summarises the impact of several of the factors he explored:

“We don’t let them play freely; we imprison them in their homes, with little to do except interact via screens; and our school system largely deadens and bores them. We feed them food that causes energy crashes, contains drug-like additives that can make them hyper, and doesn’t contain the nutrients they need. We expose them to brain-disrupting chemicals in the atmosphere.”

This is quite an indictment, but there’s only so much an individual can do. Many of the processes Hari describes are hard to escape unless you are really privileged. If you’re Bill Gates and own a small island, you can go there to get away from interruptions. Otherwise, you’re largely on your own — unless you join up with others to bring about change. Hari says there needs to be a social movement to regain the capacity to focus, a movement to support people engaging in the experience of flow in which you become totally engrossed in an activity requiring you to exercise your skills.

            As a clincher, Hari says the people of the world need their attention to deal with serious problems such as climate change. This sounds good. I followed Hari all the way with his explorations, and definitely think it’s worthwhile to cultivate the capacity to focus, and to use it regularly — including to read every word of Stolen Focus. The problem is that the power of attention can also be turned to less noble purposes such as building weapons and constructing ads. Yes, let’s join together to protect and restore our capacities to focus, but also join together for goals that help others.

Brian Martin
bmartin@uow.edu.au

Understanding resistance to vaccination

Those who don’t support vaccination are often seen as irrational. Yet, on closer inspection, the issues are not so clear-cut. Condemning “anti-vaxxers” might even be counterproductive. Better is understanding resistance to vaccination.

Given the positive connotations of “resistance” — often thought of as valiant opposition to unfairness — it might seem wrong to give this label to anyone who does not fully support vaccination, the rationale being that they are being selfish and endangering public health. Whatever your view, it can be useful to better understand the psychology and politics of vaccination.

“Resistance to vaccination” can take many forms. It includes accepting some vaccines but not others, spacing out injections, openly questioning official vaccination policies, and publicly protesting vaccination mandates. Resistance can be individual or collective.

With the advent of Covid-19, vaccination has become a high-profile personal and political issue, with nearly every adult needing to make a personal decision about whether to be vaccinated and how to relate to others depending on their vaccination status. I address resistance to Covid vaccines later.

Personally, I do not have strong views about vaccination. My interest in the vaccination issue comes from supporting the free speech of Australian vaccination critics who came under severe attack over many years.

Background

From the very first vaccine, for smallpox, there was resistance. In the 1800s in England, mandates triggered greater resistance, and even mass protests.

            In the second half of the 1900s, vaccines were introduced for an increasing number of infectious diseases, including polio, measles, pertussis (whooping cough), mumps, chickenpox and others. Most of these vaccines are recommended for children rather than adults, thus introducing an extra consideration: parents need to make vaccination decisions for their children who are too young to give informed consent.

Governments and medical authorities throughout the world recommend vaccination against a range of diseases, though the number of vaccines and preferred ages differ somewhat. Some governments apply strong pressures for vaccination whereas others do not. The greater the official and social pressures, the more relevant is the concept of resistance.

Arguments

For those who support vaccination, the arguments are pretty straightforward, summarised by the slogan “Vaccination saves lives.”

In particular, vaccines are designed to improve immunity against specific diseases, thus providing a benefit to the vaccinee (the person who is vaccinated). However, some people cannot be vaccinated or do not develop adequate immunity, for example cancer patients receiving chemotherapy who have a reduced immune function. These people are protected from infection when nearly everyone around them is immune. More generally, when nearly everyone is immune, infections have a hard time spreading. This sort of protection of those without immunity is a collective benefit.

Vaccination thus has two sorts of benefit, personal and collective. The collective benefit is often treated as generating a moral imperative that everyone should be vaccinated, to protect those with impaired immunity.

            Before proceeding further, it’s necessary to say that nearly every important claim about vaccination is disputed by some partisans — that includes both individual and collective benefits.

Turning to arguments against vaccination, the most influential is the possibility of adverse reactions to vaccines, including illness, disability and death. Critics claim adverse reactions are far more common than normally recognised. Another argument follows the line of thinking that some diseases — for example mumps — are usually harmless in childhood and give better immunity than vaccines.

Most early vaccine developers — for example, the polio vaccine pioneers Jonas Salk and Albert Sabin — gifted their discoveries to the public: they did not try to commercialise their vaccines. Beginning in the 1980s, pharmaceutical companies sought to profit from vaccine development and sales. This fed into concerns felt by some parents that the profit motive might be compromising safety.


Jonas Salk

            Decades ago, only a few vaccines were standardly available and recommended. More were added year by year, so in the US a child is now recommended to receive dozens of vaccine doses for numerous diseases. The great increase in the number of vaccines has contributed to parental reservations, especially for diseases that are rare or usually mild.

Sociologists have interviewed parents who have concerns about childhood vaccines. One of their findings is that parents with hesitations are usually well informed, well educated, and care a great deal about their children’s wellbeing. Few of them fit the caricature of being anti-rational or obsessed with conspiracy theories.

When a child seems to have an adverse reaction to a vaccine, the parents often report that doctors and health officials are sceptical, even contemptuous. These hostile attitudes can be counterproductive, causing parents to become alienated from mainstream medicine. Parents with reservations gravitate to places where they can share experiences without being shamed. When they discover vaccine-critical citizens groups, they may feel at home.

            Numerous writers about vaccine hesitancy lay blame on “anti-vaccine” information on the Internet, promulgated by campaigners. Yet it may be the other way around: vaccine-critical groups may be driven more by common experiencesthan by winning recruits through fear-mongering. A study of members of the Australian Vaccination-risks Network found that most had concerns before they joined. The implication is that such groups are more the product than the cause of concerns about vaccination.

Forms of resistance

Many parents who decide not to follow official vaccination recommendations try to keep a low profile, especially in places where unvaccinated children are stigmatised. In these cases, resistance is individual and not publicised.

When pressures to vaccinate become stronger, the stakes are raised and resistance can have bigger effects on both children and parents. In some US states, to attend school the option of religious and conscientious objection has been removed and obtaining medical exemptions made more difficult. Parents can resist this sort of pressure by finding a sympathetic doctor, moving to a different state or home-schooling.

The stronger the pressures, arguably, the more likely some parents are to seek information and support from vaccine-critical groups. Strong pressures can sometimes foster the resistance they are supposed to overcome.

            In Australia, rates of childhood vaccination have been high and stable for many years. Mainstream proponents of vaccination realised that only a few percent of parents were strongly opposed and that there were far more parents whose children were not fully vaccinated due to personal circumstances, including distance from doctors, travelling and inconvenient schedules. In this context, the most promising way to increase vaccination rates was to make it easier for parents who supported vaccination to have their children receive all their vaccines. These proponents argued for having respectful conversations with parents as the most productive way to increase vaccination rates.

However, other pro-vaccination campaigners — including Australia’s largest media organisation, News Corp — decided to target vaccine-critical groups and to get the government to remove welfare benefits from families whose children were not fully vaccinated. This campaign succeeded in stigmatising critics and increasing financial penalties but had little or no impact on vaccination rates. In this instance, resistance to vaccination was the rationale for financial penalties. It might be said that vaccine resistance became a political tool.

How should we think about resistance to vaccination?

If we think of slavery or the Nazis, it seems obvious that resistance is warranted, indeed praiseworthy. The same applies when resistance is to something that nearly everyone agrees is unjust or oppressive.

In the case of vaccination, the rights and wrongs of resistance are highly contested. From the point of view of supporters of vaccination, resistance is wrong: it is dangerous to public health. Furthermore, to publicly criticise vaccination is wrong because it may encourage refusal. Because vaccine hesitancy is such a danger, censorship and coercive measures are justified.

From the point of view of prominent critics of vaccination, resistance is valiant. They are campaigning for the right to choose, and pointing out information, unmentioned in official pronouncements, that they believe needs to be taken into account. Then there are parents, in particular those who want to learn enough to make their own informed decisions about their children’s health. Some of them decide to deviate from official recommendations. They become resisters.

Studying an issue like vaccination means being catapulted into a scientific controversy, a typical one in which most of the experts and groups with money and power are on one side and a few dissident experts and citizen groups are on the other. It’s possible to adopt a non-partisan position and just examine the methods of resistance, but more common is to decide one side is right and try to figure out how to help it overcome resistance. This is the path taken in numerous studies by supporters of vaccination.

The vaccination issue highlights the importance of the tactic of devaluation. Proponents stigmatise those who have reservations, calling them “anti-vaxxers.” Devaluation happens to resisters in a wide range of domains but is especially important in relation to vaccination, where the language of stigma has been taken up by many members of the public. In studying resistance, it is important to study the techniques used by authorities to subjugate resisters.

Note also that some critics put down those who are vaccinated as dupes or sheep, and send abuse and make threats against proponents. This is usually counterproductive.

Finally, it is important to note the enormous emphasis on vaccination as the solution to the problem of infectious disease and the consequent marginalisation of other methods of improving health, including exercise, good diet, sleep and avoidance of toxins. In a sense, the vaccination debate is a distraction: the focus should be on ways to protect and improve health. By putting so much attention on vaccination, and stigmatising and attacking critics, other contributors to ill-health are neglected. This includes cars and labour-saving devices that discourage physical activity, unhealthy foods, and the myriad chemicals that contaminate the environment. Companies that make great amounts of money from the way society is organised — from tech companies to town planners — avoid responsibility for associated harms. They are let off the hook by the focus on vaccination. The implication is to pay attention to issues that may be sidelined by the most prominent struggles.

The takeaway message is that the vaccination issue, including resistance, is not as simple and straightforward as often assumed. Learning more reveals complexities as well as insights for understanding resistance.

Covid vaccination: why is there resistance?

With the advent of the Covid-19 pandemic, governments introduced extraordinary measures to control the spread of the disease, including isolation orders, lockdowns, travel restrictions, contact tracing, testing, quarantining, distancing and mask-wearing. These were seen as temporary measures until Covid was brought under control. The hoped-for salvation was widespread vaccination.

            Vaccines became available in record time. But that was not the end of the story. As in the case of other vaccines, there was resistance. The story of Covid-vaccine resistance repeats what happened with many earlier vaccines. But there are also important differences.

First, the similarities. Covid vaccines promise a benefit to individuals, reducing their susceptibility to disease and to serious impacts, and also promise a collective benefit because the infectious agent, the coronavirus SARS-CoV-2, has fewer people susceptible to infection. The argument for vaccination appeals both to self-interest, to protect your own health, and to social responsibility, to protect others.

As in the case of other vaccines, there have been critical voices, including among doctors and scientists, raising the same sorts of concerns, specifically that the benefits of the vaccines are oversold and that the risks are greater than acknowledged. As in the case of other vaccines, critics and vaccine-hesitant individuals have been stigmatised.

Thus in many ways the controversy over Covid vaccines is nothing new. It raises many of the same issues familiar to those involved in the politics of vaccination. But there are also quite a few differences that have made the issue far greater than anything before.

What’s different about Covid vaccines?

First, Covid vaccines have been introduced in the middle of a pandemic, furthermore one in a world interconnected as never before. The stakes are higher. The enormous alarm about Covid has meant that hopes and fears about vaccines have a correspondingly higher profile.

Second, the benefits and risks from Covid vaccines have an unusual profile. As is well known, the benefits from Covid vaccines are greatest for those most vulnerable, namely those who are old and have other health problems. This is like the pattern for influenza, except the flu also can be dangerous to the very young. The risks from Covid vaccines, due to adverse reactions, seem to be greatest for those who are young. So for children and young people, there is a curious combination of low personal benefit and higher personal risk. Adding to this, most studies show that having Covid gives longer-lasting immunity than being vaccinated, so for those young people with the lowest risk of contracting Covid, there seems to be less to gain from vaccination.

Third, Covid vaccines are the first ones imposed on the entire adult population. Most other vaccines are given in childhood. In the United States, flu vaccines are recommended throughout life but are widely recognised as being only partly effective, and are compulsory only for a few occupations such as healthcare. In the history of vaccination, compulsion is often met with widespread opposition, which is why most health policy leaders have advised against mandatory vaccination. For most adults, Covid vaccines are the first occasion in which they have experienced strong pressure to vaccinate and, in some cases, severe sanctions for not doing so.

Fourth, vaccination is seen as part of a wider package of Covid control measures, including isolation orders, lockdowns, distancing and mask-wearing. Some of the control measures, especially lockdowns, have had a severe psychological and financial impact on some individuals and sectors of the population. This has led some individuals and groups to challenge the narrative presented by political leaders that “We are all in this together,” when it is obvious that some groups are prospering while others are paying a high price. Also important are the serious psychological impacts of isolation. Although vaccination imperatives are not responsible for the effects of other Covid control measures, they can be seen as part of an apparatus of oppression, a sort of guilt by association.

            Fifth, there has been extensive censorship of viewpoints contrary to official policy. For example, some critics have had their Facebook and YouTube accounts abruptly cancelled. However, because there are many alternative channels to obtain views contrary to orthodoxy, censorship may make critics, and anyone with reservations, feel unfairly treated. It can seem like there is not a free and open discussion.

Sixth, the call to be vaccinated for the good of the community comes after decades of neoliberal policies fostering individualism, using the rhetoric of personal freedom. People are encouraged to satisfy their desires through personal consumption of goods and services rather than through building shared activities with neighbours and friends. Employers have less loyalty to employees, who in turn treat jobs as stepping stones to personal advancement. Accepting a lower salary and status to serve the public has less attraction than before. In this context, suddenly people are called upon to make sacrifices for the common good. When they feel forced to make sacrifices, for example when their income is lowered, and they see elites with special privileges, this can make some want to push back against Covid controls — including vaccination.

            Given these factors, resistance to Covid control measures is not surprising.

What to do

What are the implications? This depends to a great extent on one’s position concerning vaccination, so I will separately list some possibilities for different views.

For those who do not want to receive Covid vaccines, or who oppose mandates or coercive measures, what is the most effective way to resist? This is not easy to answer at an individual level, because people’s circumstances vary so much. At a collective level, in many countries there have been public protests with thousands of people joining marches and rallies.

It is well known that the mass media selectively report violence, so when ten thousand people protest peacefully, if ten of them break windows or clash with police, that will lead the news. This means that it is very hard to assess what is going on except by being there or talking to many who were.

            Many of those involved are new to protest. To become more effective, one step would be to contact experienced nonviolent activists and develop a campaign strategy with clear goals and a variety of methods that will communicate concerns and mobilise greater support. Would silent vigils be effective? It’s hard to know but it would be worth trying to see whether a wider cross-section of the population would feel safe to participate. Clashes with police are likely to be counterproductive. Basically, protest organisers could learn a lot from experienced nonviolent campaigners. As well as protesting against, there could also be constructive actions that show what the desired future would be like.

Now consider implications for those who support Covid vaccinations and who are critical of or hostile towards those who refuse them. It is worthwhile to clarify goals. Is the goal greater levels of vaccination, or greater levels of immunity, or better health overall?

An initial suggestion is not to be so quick to condemn those who challenge or flout pressures to vaccinate. Although some refusers may be ill-informed, some have studied the issues, spent time weighing up options, and reached a considered decision. For such individuals, condemnation is unlikely to be helpful. Engaging in respectful conversations is more likely to be productive.

Vaccination mandates and censorship of Covid views contrary to orthodoxy may harden resistance. Some people oppose compulsory measures simply because they are compulsory. Another factor is that those who feel pressured to vaccinate are more likely to seek support from others with similar concerns. The result is that vaccination resistance transitions from individual to collective forms. In a sense, mandates create the very enemy — organised opposition — they are supposed to overcome.

Another implication is that resistance is about values, not just science. Talking about “following the science” is unlikely to be convincing to those who put a great priority on personal freedom, even at the expense of their own health. Furthermore, values can shape acceptance of medical authority, so it becomes a question of which authorities to invoke, mainstream or dissident.

            Some supporters of vaccination become self-righteous, assuming they hold the one and only truth about Covid. Furthermore, if they recognise the role of values, in particular the values of individual rights versus public health, they assume their own values are superior. Presuming to hold the one and only truth and that one’s values are unquestionable is a poor basis for understanding resistance.

Some of the concerns of well-informed resisters may point to genuine issues, for example the lack of information about long-term consequences of Covid vaccines, the lack of comprehensive studies of adverse reactions, the role of vested interests and the relative neglect of preventatives and treatments, especially using nonpatentable substances such as vitamin D and ivermectin. It is possible to learn from resisters about ways to make vaccination more credible to at least some of its critics.

It may be possible to find common cause with some Covid vaccine critics. For example, agreement might be possible over non-vaccine ways to reduce the harms from Covid, such as encouraging exercise and protecting those who are most vulnerable.

When lives are at stake and some people seem to be flouting basic advice for the common good, it is tempting to attack, condemn and use coercive measures. It would be more productive to show respect, learn from critics and join together in whatever ways are possible.

Brian Martin
bmartin@uow.edu.au

Thanks to Bob Dildine, Kelly Gates, Julia LeMonde and Tom Weber for helpful comments on drafts, and to many others for stimulating discussions on vaccination issues.

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On Covid protesting

Many people have protested against Covid control measures. How can their efforts be made more effective? Should they be?


Covid protest, Melbourne, 2020

After the first major Australian public protests against lockdowns, everywhere I looked there was condemnation. Media stories highlighted violent incidents and reported that right-wing extremists were involved. Many protesters were not wearing masks, so the danger of Covid transmission was emphasised. Some prominent left-wing figures criticised the protesters, siding with the police for a change.

I thought, “Not so quick.” It is standard for media reports to focus on the negative aspects of protests, especially violence. I was reminded of protests against nuclear war back in the 1980s. Opponents dismissed the protesters as uninformed and as tools of the Soviet Union. Didn’t they know nuclear weapons are there to protect us?

Here I’m going to present some ideas from research on protest movement strategy and comment about how these ideas can apply to resistance to Covid control measures. For those who oppose Covid protests, there are a few suggestions at the end.

Why would I want to suggest ways for Covid protests to be more effective? Most importantly, if people are going to protest, I think it’s better for all of us when they use nonviolent methods — whether or not you or I agree with their goals. Many of those involved are first-time protesters, and it would be good if they developed their understanding and skills. You never know when you might want them on your side.


Covid protest in France

Background

Governments around the world have responded to the Covid-19 pandemic with a variety of control measures, including distancing, quarantining, masking, lockdowns and promotion of vaccination. Many governments have used Covid as a justification for restrictions on civil liberties. In many places, there has been resistance to these measures, including massive protests.

In Australia, government leaders have condemned the protests and the protesters, while mass media have mostly ignored or condemned them. A common response is to say that control measures are to protect the public from a dangerous disease and that protesters are being irresponsible: they are threatening public health. My impression is that the same sort of response to protests occurs in many other countries.

My personal background is relevant to this issue in two ways. Since the late 1970s, I’ve been studying scientific controversies, including the ones over nuclear power, pesticides, fluoridation, the origin of AIDS — and vaccination.

Also since the late 1970s, I’ve been involved with social movements, including the movement against nuclear power and the peace movement. Related to this, I’ve studied nonviolent action, which refers to methods like rallies, strikes, boycotts and sit-ins. As well, I compiled a collection of resources for resisting repression in Australia.


Covid protest in Berlin

Covid protest rallies fit the usual model of protest: people have a grievance or a social concern and join together to express their feelings in the hope of promoting change in policies or practices. The strange thing is that so many activists from other movements seem to have stayed away, and furthermore to condemn the protesters. They hear about Covid protesters who are linked to right-wing extremists, or who have weird ideas, and dismiss the protesters as dangerous and ignorant.

Controversy

Concerning Covid, most governments and health authorities have adopted a standard view, that the pandemic is a major threat to public health warranting extreme measures to control the threat. However, the standard view has been contested by some researchers and doctors. This is a typical public scientific controversy, similar in many ways to others I have studied. There is disagreement about technical matters and the technical disagreements are mixed in with differences about ethics and decision-making.

There are actually several Covid controversies. One is over the origin of Covid: wet markets or lab leak. Others are over the seriousness of Covid, treatments for the disease, vaccination, masks and lockdowns.


Lab leak or wet market?

As with many other controversies, such as over climate change, genetic modification and fluoridation, those on the side of scientific orthodoxy say critics are ill-informed, ignorant and dangerous, and that governments and the public should trust the experts. They assume there is only one rational response and that anyone who disagrees is “anti-science.” This obscures the role of differences in values. In disputes over Covid control measures, there are differences in values placed on controlling Covid versus freedom of movement and assembly.

Here I’m going to offer some ideas about Covid protests drawn from the theory and practice of nonviolent action. These ideas are fairly general because I haven’t participated in any protests and because there is so much variation in experiences from place to place, worldwide and even within Australia. Those opposed to Covid protests can skip to my remarks in the final section.


Covid protest in London

Getting the message out

Rallies and civil disobedience are good for showing passion, commitment and breadth of concern, but they are not so good for communicating the reasons people are protesting. Media coverage, if there is any, is usually more about the events than the issues. Protesters can carry placards and banners, but these are too brief to communicate much about the evidence and arguments.

A social movement needs a communication strategy. One important aspect is self-education. Participants need to learn about the issue, including facts and arguments, and how to counter contrary viewpoints. Just because people join together on the streets doesn’t mean they have a deep understanding of the issues. This is nothing new. It has been true of many other movements.

A few members are highly knowledgeable. They know about all sorts of scientific research, about ethical arguments and much else. The challenge is for others in the movement to learn from them. In anti-war movements of yore, one technique was the teach-in, in which knowledgeable speakers would explain issues. These days, this can be done online. It’s like a classroom, with a priority on interactive learning.

The ideal, which can never be reached, is for every person at a rally to be knowledgeable enough so that they can give a good account to a journalist or an observer. This will seldom be possible, so those who have a better grasp of the issues or are more articulate need to take the lead in talking with others.

At a rally, speakers usually try to fire up the crowd with powerful rhetoric. This is good for building a sense of a common cause but not for educating the public. It is speaking to the converted. This needs to be supplemented by a strategy to reach those who are neutral or sceptical.


Door canvasser

There are various options, such as going door to door inviting conversations, holding information meetings (online or face to face) and circulating leaflets and links. This doesn’t sound exciting. It doesn’t have the emotional impact of joining a rally, but it is the foundation of any effort to change people’s views.

A crucial part of a communication strategy is to show to others that campaigners, and people with concerns, are human, ordinary people. Given the rhetoric that anyone sceptical of the official Covid line is some sort of lunatic who doesn’t care about others’ health and welfare, it is vital that campaigners come across as sensible, reasonable, considerate and, when possible, just like other people. Messages are most persuasive when the sender is similar to the receiver in age, occupation and other characteristics.

Action

Gene Sharp in his classic book The Politics of Nonviolent Action presents the “dynamics of nonviolent action,” which is a series of stages or features of nonviolent campaigns. He developed this framework by studying numerous campaigns, such as the Indian independence struggle and the US civil rights movement. It’s worth considering how Sharp’s dynamics framework applies to campaigning against Covid control measures.

Sharp calls the first stage “laying the groundwork.” It involves communicating with supporters, building organisations and networks, developing skills and preparing for action. Laying the groundwork is a vital part of any campaign, done before taking strong action. Without sufficient preparation, movements are more likely to fade away after the initial excitement.

Covid protester organisers, however, seem to have put in relatively little effort in laying the groundwork. Instead, they have gone straight to action, calling rallies before there has been time to build the capacity of the movement. This has been possible due to social media, which enables rapid mobilisation, unlike what was possible just a few decades ago. Zeynep Tufekci in her book Twitter and Tear Gas describes the problems that can arise from mobilisation with relatively little preparation, for example in Turkey and Egypt: often there is a big impact in a short time, but without the foundations of trust and decision-making processes, the movement is susceptible to pushback from authorities, and some early gains are lost, as in Egypt after the toppling of dictator Hosni Mubarak.


Cairo, 25 January 2011

Sharp’s second stage is “challenge brings repression.” When the movement takes action against authorities, this often leads to police attacks on activists, for example beatings, arrests and shootings.

In some countries, police have been heavy-handed in shutting down Covid protests. More commonly, though, protests have been tolerated with not so much repression. The reason is that, in many countries, rallies are a regular and accepted method of protest and, in Sharp’s terms, do not constitute nonviolent action. However, when gathering in public places is banned, as with lockdown rules, a public protest is indeed a challenge to authorities and may be met with harsh measures.

What sort of action is most effective?

A challenge to authorities may bring repression, but there’s a prior question: what sort of challenge is most effective? Movements around the world have used mass rallies to challenge dictatorial rulers, and because such mass events are so visually striking, they can be seen as the essence of social action. However, rallies alone are usually not enough to bring about significant change. Also needed are other methods, and there are a lot of them, ranging from vigils to strikes to alternative economic systems.

In deciding what action to take, there are several considerations. One is to enable participation by as many people as possible, from different walks of life. This builds the movement. Another consideration is to make the action as meaningful and empowering as possible for participants. This also builds the movement. Thirdly, ideally the methods used in the action should be ones compatible with the goal being sought. There are other considerations too. How will members of the public react? How will the police react? Choosing the right action is not a simple matter.


Covid protest in Italy

In the age of Covid, many people are deeply frightened of catching the disease. Therefore, when they see large crowds of people protesting, not wearing masks and not keeping distance, they are frightened. The crowds may be outside, where the risk of transmitting an infection is far less than indoors, but that doesn’t do much to reduce the fear. So what about other actions? What about a silent march, single file, wearing masks and carrying candles? This would be less threatening, many people can join in and it might be more moving for those involved.

It’s useful to think of two sorts of actions: those that resist injustice and those that help build an alternative world. Imagine a stall in which activists pass out free vitamin D capsules. Vitamin D is cheap and not patentable, and some research suggests it reduces the risk of contracting Covid. This sort of action could generate attention to alternatives to control measures.

Remaining nonviolent

There is one other vital consideration: not using violence. The third element in Sharp’s dynamics of nonviolent action is “solidarity and discipline to fight repression.” The key is to “maintain nonviolent discipline”. By this, Sharp means not using physical violence against police or other authorities. If there’s a rally of a thousand people and two of them throw bricks through shop windows and try to fight police, their behaviour can discredit the whole protest and become a pretext for police violence against the entire group.

Here’s the situation. When no one protesting uses any violence, then if police attack, it can be seen by many observers as unfair, and this can generate sympathy for the protesters. However, if any protesters use violence, this turns the engagement into a contest – a violent confrontation – and the police have all the advantages.

Experienced nonviolent campaigners try to ensure nonviolent discipline by announcing publicly that they are committed to remaining peaceful and by arranging for participants to go through some preparation beforehand so they don’t react to provocations.

In 1960 in Nashville, Tennessee, Black activists in the US civil rights movement wanted to challenge segregation and made plans to sit at lunch counters. They knew they would be attacked, so they spent months preparing, including being able to sit while whites yelled insults and police made arrests. Their preparations paid off, leading to the ending of restaurant segregation in the city.


Lunch-counter protesters attacked in Nashville, 1960

For many Covid protests, there is no preparation at all. People show up with no experience. It’s amazing that so many rallies have been completely peaceful. Preparation would help to reduce the risk of being discredited due to the violence of a few.

Even yelling abuse at the police or politicians can be counterproductive. Being aggressive in any way signals to observers that the protesters are unruly, inconsiderate, even dangerous. Furthermore, it scares away potential participants, for example ones with children.

Then there are opponents of Covid measures who send abuse to prominent figures such as Anthony Fauci. Some send death threats. This is disastrously counterproductive. These opponents sound tough but in practice serve to alienate potential supporters.

Sensible campaigners should publicly condemn abuse and threats targeted against those on the other side, and exclude anyone who they know uses abuse and threats. If there’s one thing that will discredit a movement, especially one with fewer numbers, it’s being abusive and threatening.

When movements start to become strong, and remain nonviolent, one thing police often do is use agents, who pretend to be activists, to encourage the use of violence. There was one incident in Australia, in 2016, in which pro-vaccination campaigners apparently tried to fake Twitter messages to appear like abuse from vaccine critics.

This all ties in with Sharp’s next stage, political jiu-jitsu. When police attack peaceful protesters — ones who maintain nonviolent discipline in spite of provocations — this can often lead to greater support for the movement. There are famous instances, for example in India in 1930, South Africa in 1960, East Timor in 1991. A similar process occurred in 2020 with the murder of George Floyd, triggering a massive expansion of the Black Lives Matter movement. This process of political jiu-jitsu can be observed, on a small scale, in the mobilising impact of videos showing police abusing Covid protesters.

Aftermath of Sharpeville massacre, South Africa, 1960

However, police brutality doesn’t always lead to political jiu-jitsu. Police have regular ways of reducing public outrage. Activists need to learn how to counter police tactics of outrage management.

There are more stages in Sharp’s dynamics and more I could say about making campaigns effective, but this is enough for now. There is a lot of writing about how to build social movements, including Bill Moyer’s Movement Action Plan and Mark and Paul Engler’s book This Is an Uprising. There are many experienced nonviolent activists in a range of movements, for example climate campaigners. My advice would be to make contact with experienced activists, get their advice and learn from them. Some may not be willing to help Covid protesters, but some will. Some may be sympathetic to protest goals, and some may think, “I don’t agree with your goals but if you’re going to protest it’s better to do it following nonviolence principles.”

One last point: prepare for a long struggle. When people first join a rally or a protest group, they come with enthusiasm that success is not far away. After all, they know they have justice on their side and all that’s needed is to help others to see the truth. This isn’t the way it works. Your truths may be heresy to others. Many campaigns go on for decades. Think of nuclear power, fluoridation, animal rights and climate change. Covid struggles might be with us for a very long time. Maybe not, but it’s better to prepare for a long struggle, indeed for one in which things get worse before they get better.


Covid protest, Washington state, USA

The other side

What if you think Covid protesters are deluded and dangerous? What’s the best way to respond?

  1. Discourage attacks. Every time police are heavy-handed with a protester, there’s a chance of turning the protester into a martyr. Remember political jiu-jitsu.
  2. Oppose mandates, such as vaccination mandates, and coercive measures. These are likely to foster greater resentment and resistance.
  3. Encourage responsible protest. If people are going to protest, it’s better if they do so with less risk to public health and less danger to police and bystanders.
  4. Engage in respectful conversations with people who have contrary views. Learn about their concerns and suggest ways forward.
  5. Search for common interests. Most people are concerned about wellbeing but they may have different ideas about how to achieve it. For example, it may be possible to agree on encouraging exercise, which can improve health and the immune system, even while disagreeing about lockdowns or vaccinations.


Running protest against racial injustice, USA

These methods won’t end the divisions and the conflict, but at least they won’t make things worse. Remember, Covid conflicts may be with us for a long time, so it’s worth finding ways to manage the conflict that bring out the better side of human nature.

Brian Martin
bmartin@uow.edu.au

For valuable comments, thanks to Paula Arvela, Anneleis Humphries, Julia LeMonde, Monika Onken and others who prefer not to be named.

Other posts and articles about Covid